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Benefits, costs weigh on proton therapy

Joel Rose Nov 30, 2009

Benefits, costs weigh on proton therapy

Joel Rose Nov 30, 2009

CORRECTION: The original version of this story misstated the number of proton therapy centers in the United States. There are seven, with more on the way. The correct number has been inserted in the text below.


Kai Ryssdal: I know it feels like the health-care discussion has been going on for months. And sure, it has. But today the Senate really got down to it. As debate on the Senate’s final bill got started this morning, majority leader Harry Reid said he and his colleagues would be working weekends to wrap things up as quickly as possible.

So far a lot of the attention has been on health insurance, how health care is paid for. Far less work is being done on containing those costs. Costs that continue to rise in part because newer treatments and medicines tend to be pricier than existing ones are. And yet they don’t always produce better results.

Today, as part of “The Cure,” our ongoing coverage of the health-care overhaul, one of the thorniest questions in the whole debate: How to balance innovation and cost control? Joel Rose went to the University of Pennsylvania to check out a cutting-edge cancer therapy.

JOEL ROSE: In the basement of Penn’s new proton therapy center, facility manager Eric Backes shows me a big, round metal object that looks like a small submarine. He nearly has to shout to be heard over the fans keeping it cool.

ERIC Backes: It’s basically a 220-ton magnet. The cyclotron spins the protons around and shoots them out through the beam line.

The cyclotron creates a beam that’s more precise than other forms of radiation, so doctors can direct it exactly where it’s needed.

STEPHEN Hahn: If you’re able to give a higher dose of treatment and have less side effects, that’s a great win-win situation.

Stephen Hahn is chair of radiation oncology at the University of Pennsylvania. He says conventional radiation can badly damage the healthy tissue around tumors. Hahn hopes proton therapy will help treat cancers where tumors are close to vital organs.

Hahn: The physics of protons are undeniable. If protons were the same price for treating a patient as regular radiation, we would not be having this discussion.

But the price is not the same. Proton therapy centers are expensive: this one cost $140 million. And the treatment typically costs 50 percent more than conventional radiation. That contributes to higher medical bills and indirectly, to higher insurance premiums for the rest of us.

BOB Marckini: I got mine. I received my treatment. And I’m proof positive that it works. That you don’t have to give up your sexual function or your urinary function.

This is Bob Marckini — A.K.A. Proton Bob. He was treated for prostate cancer nine years ago, without any of the nasty side effects that can accompany surgery or radiation. Since then, he’s become somewhat of an evangelist for proton therapy. He started a volunteer organization of men who’ve had the treatment for prostate cancer. It has more than 4,000 members.

Marckini: At any one given day, one of our members, or two or three or four, are standing up in front of a group some place giving a presentation on treatment options, and in particular, proton therapy. That is causing an increase in demand, and that delights me.

That demand hasn’t gone unnoticed by hospitals. There are seven proton therapy centers in the U.S., with more on the way. Hospitals see proton therapy as a way to distinguish themselves regionally and nationally by treating cancers others hospitals can’t. But these facilities take an enormous investment, and that means pressure to generate income.

Anthony Zietman is an oncologist at Massachusetts General Hospital.

ANTHONY Zietman: The best way to do that is to treat as many patients as you possibly can. So from a business perspective, it makes great sense to treat prostate-cancer patients.

Even if those patients don’t need it. Zietman says many prostate cancers are slow growing, and don’t require treatment at all. For those that do, Zietman says there’s still no clinical evidence that protons are a big improvement over cheaper alternatives.

Zietman: That’s the reason why University of Pennsylvania and Mass General are trying to do a randomized trial comparing one treatment with another. At least we’ll be able to quantify if proton beam is superior in prostate cancer, and by how much.

The University of Pennsylvania’s Stephen Hahn is convinced that proton therapy will prove indispensable for treating certain childhood cancers, and head, neck and lung cancers.

Hahn: If we can define the patients where proton therapy really does benefit them, then I would say as a society we have to come up with the money to do this, because it’s the best thing for cancer patients.

Just maybe not all cancer patients. But once you’re spent more than $100 million on a proton therapy center, it can be awfully hard to say no.

In Philadelphia, I’m Joel Rose for Marketplace.

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