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Post by Tony Crispino on Aug 6, 2014 14:48:45 GMT -8
John, great post... I think key data referenced in the article is a retrospective Prostate Cancer Clinical study comparing toxicity. In that study the following conclusion was drawn: "Although PRT is substantially more costly than IMRT, there was no difference in toxicity in a comprehensive cohort of Medicare beneficiaries with prostate cancer at 12 months post-treatment." It really does not take a Harvard training to ask the question to an institution that has been using this modality for over 20 years "where's your published data?". There is no question that when LLMC started out PBT was way better than the EBRT options available in 1994. But as Brian states in his article: "It is incumbent on proton therapy researchers and clinicians to demonstrate the superiority of PBT over existing, less costly technologies. Efficacy data will need to prove that PBT is either more effective (i.e. better tumor control), reduces toxicity (complications and side effects) and/or improves patient-reported quality of life. I am a strong believer that high-quality studies will eventually support these findings for many cancers." This would indicate that while maybe a better technology, there is a huge question that we may be bringing a nuclear bomb to a gun fight with prostate cancer treatment. I recommend the article John just linked to anyone interested. There are some terrific references and links in that article. Also note: That MD Anderson, in cooperation with Harvard, are performing a clinical trial today and LLMC is not a participating center. I believe that is no surprise. But Brian still leaves open the possibility that better trials and better data could still prove PBT as superior. Did ASTRO and Lancet go too far? I don't think so. They are calling for better data. And they do outline cases where PBT may be appropriate: In identifying and describing appropriate use of proton-beam therapy, the policy lists four circumstances when use of the technology is reasonable:- Target volume is close to a critical structure, requiring a steep dose gradient outside the target to limit the structure's exposure. - A decrease in dose inhomogeneity in a large treatment volume is required to avoid an excessive "hotspot" within the target volume. - Use of photon-based therapy carries an increased risk of clinically meaningful normal-tissue toxicity. - The same area or an adjacent area has been previously irradiated, increasing the need for sculpting to limit the cumulative radiation dose. "The policy emphasizes that "proton-beam therapy is not considered reasonable and medically necessary unless at least one of the criteria listed ... is present." That quoted language is linked in Dr. Lawenda's article. Click HereThank you Dr. Lawenda for the great information... |
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Post by Allen on Aug 6, 2014 20:56:07 GMT -8
It isn't exactly the case that Loma Linda has not published. They did in 2004, reporting on 1,961 patients treated from 1991-1997, some with a combination of protons and photons. They did not stratify their oncological results by the D'Amico risk categories, but we can get a sense by the risk categories they looked at. There was very low incidence of any Grade 3 acute and late term urinary and rectal side effects, Effects on erectile function are not mentioned. slater_2004_1.pdf (94.53 KB) | 5 year freedom from biochemical relapse | | PSA≤4 | 90% | | PSA 4.1-10.0 | 84% | | PSA 10.1-20.0 | 65% | | PSA>20 | 48% |
| GS 2-4 | 82% | | GS 5-7 | 73% | | GS 8-10 | 50% |
Clearly, these are not results one would brag about now, but were probably similar to the results of brachy or EBRT in those days before dose escalation. For comparison, the 5-year results reported by UF Jacksonville last year look a LOT better: Five-Year Outcomes from 3 Prospective Trials of Image-Guided Proton Therapy for Prostate Cancer| NCCN Risk Category | 5-yr freedom from biochemical relapse | | Low Risk | 99% (n=89) (20 were very low risk) | | Intermediate Risk | 99% (n=82) (54 favorable, 28 unfavorable) | | High Risk | 76%* (n=40) |
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Post by lupronjim on Aug 26, 2014 14:21:06 GMT -8
Just got this email
Brotherhood of the Balloon - Special Call to Action
Help preserve proton therapy in IL, MT, NM, OK and TX Deadline: MONDAY, SEPTEMBER 1, 2014
Please act before MONDAY, September 1, 2014
You can make a difference!
Dear BOB Members:
There is an important step you can take to help others (including family members and friends) who could benefit from proton therapy in the future. It will only take a few minutes. Time is of the essence, so we need your help today.
Directions for helping in this effort are at the bottom of this message.
BCBS in 5 States Plan to Stop Covering Proton for Prostate Cancer
There is a real and serious threat to the future of proton therapy for the treatment of prostate cancer. Health Care Services Corporation (HCSC) is the largest customer-owned health insurance company in the United States. Their subsidiaries include Blue Cross Blue Shield of Illinois, Montana, New Mexico, Oklahoma, and Texas. Roughly 1,000 of our members, or 14%, live in these states.
HCSC is proposing to change their policy and stop paying for proton therapy for prostate cancer beginning on January 1, 2015. The reason, they state, is that "clinical outcomes have not demonstrated this modality (proton) as superior to, or more effective than, established less costly radiotherapy modalities."
We Who Have Had Proton Treatment Understand the Benefits
The fact is, the laws of physics and science point to proton being superior to other forms of radiation therapy because most of the proton radiation is deposited on the target tumor and not on healthy tissue. This means the patient can expect fewer side effects and a low probability of secondary cancers later in life.
Studies comparing proton therapy to conventional radiation on many tumor sites, other than prostates, show significant benefits in terms of cure rates and minimizing the risk of secondary cancers. We should expect the same to be true when treating prostates.
Surveys conducted on former prostate cancer proton patients, including one done earlier this year, showed extremely high cure rates and very low rates of side effects.
Clinical studies comparing proton therapy to other radiotherapy options are either ongoing or are planned. Other clinical trials are underway to reduce the cost of proton therapy. We need to encourage private insurers like HCSC to continue covering proton therapy for prostate cancer while these trials are underway.
Here's How You Can Help
There is an open comment period on this proposed policy change which ENDS THIS MONDAY, SEPTEMBER 1, 2014. If you object to HCSC's proposed policy change that would affect Blue Cross Blue Shield patients in Illinois, Montana, New Mexico, Oklahoma, and Texas, please send your comments to HCSC BEFORE MONDAY.
Your response does not have to be long or complicated. Just tell them about your experience of proton therapy and your quality of life after treatment, and ask them to continue covering proton therapy so that others will have the opportunity to benefit from a treatment that both cures cancer and preserves quality of life.
Directions for Sending Your Comments
Click here to post your comment.
Click the "I agree" button at the bottom of the Medical Policies statement.
Click "Draft Policies."
Click "Charged-Particle (Proton and Helium Ion) Radiation Therapy."
Click "Comment on this Policy" (right side of page).
Enter your name and email address (required).
The following fields are OPTIONAL: Specialty, state, and phone.
For those of you who are in the medical field, you can likely find your specialty in the Specialty menu. If you are not in the medical field, leave this field blank, or choose "Mixed Group" at the bottom of the pull-down menu.
Add your note in the "Comments" field and be sure to let them know you disagree with the proposed policy change and request they continue covering proton therapy for prostate cancer.
Click "Submit."
Your action here is very important. If these Blue Cross companies deny proton coverage for prostate cancer, other insurers will likely follow. We cannot allow this to happen. Our family members, friends, and others must have access to proton therapy in the future.
Please send your comments to HCSC BEFORE THIS MONDAY, SEPTEMBER 1. The comment period ends at the end of the day.
If you happen to open this email after September 1, 2014, I encourage you to send in your comments anyway. It's possible that comments that come in after the deadline will be taken into consideration as they finalize their policy decision.
Thank you in advance for taking this action. We must work together to prevent this proposed policy change. The more of us who respond, the greater will be the chance we can turn this around.
Bob Marckini
PS: If you have any questions or are having difficulty providing a response to HCSC, contact Deb Hickey at DHickey@protonbob.com or Becky Campbell at BCampbell@protonbob.com .
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