Although the evidence on its efficacy is mixed, as costs fall, more and more health systems are investing in proton therapy.

Proton therapy uses targeted forms of radiation to combat cancer while limiting exposure. Its cost is decreasing, which is expected to drive investment in the next few years. But many proton therapy centers are still trying to attract enough patients or high enough reimbursement to justify the investment. Science does not give Proton a clear advantage More than photons.

Dr. Peter Johnston, interim chairman and clinical director of the Department of Radiation Oncology, Moffett Cancer Center, said: “As protons discover head and neck cancers become easier and easier, there is great potential” and pointed out that more and more hospitals and cancers As the equipment becomes smaller and cheaper, people including Moffitt are exploring the addition of proton therapy centers. “But no matter what you do, there will always be marketing gimmicks-new technologies appear every time you turn around.”

Proponents claim that the ability of proton therapy to reduce the collateral damage of cancer treatment exceeds a large amount of capital expenditure. Compared with traditional radiation, it has fewer side effects and has significant benefits for pediatric patients. Others point to the limited evidence that proton therapy is more effective than traditional radiotherapy, claiming that proton therapy is primarily a marketing strategy that drives up the cost of healthcare.

Many proton therapy centers have applied Chapter 11 Bankruptcy Protection Because they have been trying to get enough patients. According to the bankruptcy petition filed by the Tennessee District Court in November, the latest is Provision CARES Proton Therapy Knoxville, which plans to sell almost all of its assets for approximately $87 million.

Covenant Health will pay more than $45 million for Provision’s Proton Therapy Center in Knoxville. Provision Trust is a non-profit foundation headquartered in Tennessee. It will spend US$26.5 million to build a proton therapy center in Franklin, Tennessee, and spend US$15.5 million to build a near-completion center in Hamlin, Florida. The construction cost is approximately 95 million U.S. dollars.

Before the COVID-19 pandemic, the Knoxville Center treated an average of 66 people a day, while another facility in Tennessee treated about 43 people. Their maximum capacity is about 90 people per day.

These numbers plus lower-than-expected solvency rates are not enough to sustain the development of these centers, which have defaulted on the bond issue and have been relying on credit. According to Court documents.

“If there is no patient movement, one of the most difficult things is to bear the cost of the Proton Center,” said Johnson, who works in Moffett, Tampa, Florida. “There will always be people with money rather than reason, which is why there is a cyclotron 60 miles away with no patients.”

The center of Provision uses the most accurate form of proton therapy called “pencil beam scanning”, which uses a millimeter-wide beam to protect organs and tissues from radiation. Low-dose radiation enters the human body through protons, matches the shape and depth of the tumor, and deposits most of the energy into the mass.

According to court documents, in general, the cost of proton therapy per treatment room is estimated to be 32 million U.S. dollars. There are about three dozen proton centers in the country.

Dr. Harry Greenspun, chief medical officer of the consulting firm Navigant, said: “This is a marketing tool, not a result tool, and it can be costly.” “These types of centers usually have a lot of hype and marketing appeal-people want cutting-edge Things. But some of these treatments are beyond their true capabilities.”

The Memorial Sloan Kettering Cancer Center, Mount Sinai Health System, and Montefiore Health System established the New York Proton Center about two years ago. The US$300 million facility in East Harlem has treated approximately 1,500 patients with cancer, including brain cancer, head and neck cancer, breast cancer, lung cancer, gastrointestinal cancer, prostate cancer, and pediatric cancer.

NYPC executives said it reduces side effects and improves the quality of life of patients.

New York Proton Center CEO Jonathan Weinbach (Jonathan Weinbach) said: “Most parts of the country don’t know how incredible this technology is.” He added that coverage is expanding. “Recently published articles show that almost every disease site has clear survival and side effects benefits.”

Still commercial Insurance company denies He said about 70% of the claims.

“The long-term benefits of proton therapy will reduce costs,” Weinbach said. “But insurance companies don’t consider long-term costs. It’s a pity-missed opportunities.”

According to a 2019 study, compared with traditional photon radiotherapy, proton therapy is associated with a reduction of nearly two-thirds of the unplanned hospitalization rate 90 days after treatment. analyze Nearly 1,500 patients were published in the Journal of the American Medical Association.

However, the survival rates of the two cohorts were similar. The researchers said that although promising results have been achieved in proton therapy to reduce toxicity, the theory has not yet been confirmed.

Given some of the limitations of the study, “the evidence needed to truly justify the cost of proton therapy… needs to come from a phase 3 randomized clinical trial,” wrote Dr. Henry Park and Dr. James Yu, radiation oncologists at Yale University.Medicine, writes in the attachment editorial.

Dr. Jeffrey Balser, President and CEO of Vanderbilt University Medical Center, said that proton therapy can bring more benefits to a small number of patients than radiotherapy.

“I’m still not optimistic,” he said, adding that there are more failures than successes. “The number of clear indications for proton therapy is limited. But this situation will change.”

The University of Kansas Health System plans to open a proton therapy center early next year. It will be the first in the state and its surrounding states, including Iowa, Nebraska, Colorado and Arkansas. The Mayo Clinic plans to expand its Proton Therapy Center in Rochester by 110,000 square feet at a cost of $200 million. McLaren Health Care will spend US$46 million to expand its proton therapy center in Flint, Michigan.

“There are things you can do with protons and you can’t do with linear accelerators,” Johnstone said, noting that skull base tumors and other targeted therapies, especially for children. “The health system will be interested because the technology is smaller and cheaper.”

Unfortunately, the number of cancer cases that are expected to require radiation therapy is on the rise. Brant Phillips, an attorney at the Bass, Berry & Sims law firm, said he had provided proof of demand for the proton therapy center.

“The million-dollar question is when, when and how commercial payers will be more flexible in reimbursing this care and at what rate,” he said. “As the number of centers continues to increase, especially as technology continues to allow proton microbeam therapy with much less capital expenditure, we will see more evidence-based information, and commercial insurance companies say they want to see this. Information to prove its reasonable proton therapy coverage is wider.”

Phillips said if Memphis is the next logical location for another factory in Tennessee.

“Considering the central location of Memphis in South Central, this is the next obvious location for another facility,” he said, noting that the Proton Center at St. Jude Children’s Research Hospital in Memphis is exclusively for hospital use and is limited to pediatric cases. “I hope that regulators can strongly support such resources in the Memphis area, especially when there is cooperation between suppliers.”