As the Hampton University Proton Therapy Institute completes its third year of treating cancer patients — half of them for prostate cancer — insurance companies across the country are dropping coverage for proton beam therapy for early stage prostate cancer.
Most recently, Blue Shield of California announced it would join their ranks. Before that, Aetna Insurance, the nation's third largest insurer, stopped covering the procedure, and Cigna announced it would review its policy, according to Medscape Medical News, an online medical journal.
Their rationale is that the highly targeted radiation beam used in proton therapy is significantly more expensive — the median Medicare reimbursement for prostate cancer treatment was reported by the National Association for Proton Therapy as $32,428 as compared to $18,575 for IMRT, intensity-modulated radiation therapy — while the difference in outcomes has not proven significant.
Allan Thornton, a radiation oncologist at HUPTI and a 22-year veteran of proton beam therapy, disagrees. "I have never argued that proton therapy is more effective than conventional for prostate cancer — provided the dose is the same," he said, noting that conventional radiation often uses higher doses. "Logically they'd have the same cure rate,"
For Thornton, the key issue is not in mortality statistics, but in the associated complications that insurance does not take into consideration. "They're not considering the issue of side effects. Proton therapy is much less damaging to the rectum," he said. Thornton cited peer-reviewed studies, by Gerry Slater at Loma Linda University Medical Center in California and William Mendenhall at the University of Florida, detailing severe, chronic rectal complications — bleeding, non-healing sores, fistulas — at a rate of 1 percent among proton therapy patients and between 7 and 9 percent among those receiving conventional therapy.
"Society has to decide what a 7 percent savings in rectal complications is worth. Insurance companies are doing it in a cost-savings manner," he said. Thornton warned that insurance denials could lead to a segregated system in which only the wealthy have access to proton therapy.
When the $225 million HUPTI facility opened in September 2010, Hampton University President William Harvey predicted that it would treat more than 2,000 cancer patients a year, of whom two-thirds would be for prostate cancer. Currently about half its patients are being treated for prostate cancer, Thornton said, with the number declining as the institute adapts to insurance constraints.
"We've been shifting our focus to children, head, neck, and brain tumors. There are very few that can be treated with conventional therapy," said Thornton. Lung and breast cancers are also excellent candidates for proton therapy treatment, he added.Copyright © 2014, The Baltimore Sun