Proton therapy has been touted as the next big thing in cancer care. The massive machines, housed in facilities the size of football fields, have been sprouting up across the country for a decade.
Fourteen proton therapy centers in the U.S. are up and running, and another dozen facilities – including a $200 million Midtown site being built by Emory Healthcare – are under construction or in planning stages nationwide.
Indiana University shocked many experts who watch the industry last month when it announced that it plans to close down its facility in Bloomington, as reported by Modern Healthcare.
“I never thought that in my lifetime I would see a proton center close,” says Amitabh Chandra, a professor at Harvard’s Kennedy School of Government who studies the cost of American medical care.
He’s surprised because until now, industry growth has been entirely in the other direction, even though there’s little evidence that proton therapy is better than standard radiation for all but a few very rare cancers.
“But we do know it is substantially more expensive and substantially more lucrative for physicians and providers to use this technology,” Chandra says.
Advance Particle Therapy LLC will run Emory’s proton therapy center, which will be staffed by Emory doctors. The company’s CEO, Jeff L. Bordok, said in an emailed statement to the AJC that the closing of the Indiana University center was perhaps not so surprising. The center, he wrote, was “repurposed from an existing cyclotron installed in the 1970s. With the advancements in proton therapy technology, the equipment would have required significant capital investment.”
Bordok also noted that the closest proton therapy center to Atlanta is in Jacksonville, which is part of the reason, he said, that the state approved the Emory center.
'Not been shown to be any more effective'
In the Washington area alone, three proton therapy centers are under construction — at Johns Hopkins University, Georgetown University and the University of Maryland in Baltimore next year.
All three say they are continuing to build their centers, despite the news out of Bloomington. In email statements, two said that the larger population of the D.C.-Baltimore area can support a proton facility better than a small city like Bloomington. The third said it’s building a smaller, one-room center that will be more cost effective.
A review committee in Indiana determined that updating the proton facility there would cost more than it would yield. One reason for the closure is that insurers have been refusing to cover the treatment for common diseases such as prostate and breast cancer. Cigna, for example, only covers proton therapy for a single rare eye cancer, says Dr. David Finley, the insurer’s national medical officer.
“When it’s used, however, for all other tumors, it’s not been shown to be any more effective than other forms of radiation therapy,” says Finley.
Proton beam therapy costs three to six times as much as standard radiation therapy for illnesses like prostate cancer, according to Finley. He adds that when insurers pay for expensive care that isn’t any better than the cheaper options, it can increase the cost of everyone’s health care.
“We said if two services offer the same result and one is much more expensive than the other one, we’re only going to pay for the one that is less expensive,” Finley says.
Other major insurers have also limited what they’ll cover with proton therapy, including Aetna and Blue Shield of California.
‘It covers dubious treatments extremely generously’
In his statement to the AJC, Bordok of Advance Particle Therapy defended the treatment, saying it spares more healthy tissue from radiation damage than more conventional x-ray treatments. This, he said, cuts down on side effects. He cited other studies showing that proton therapy can be competitive on cost with x-ray therapy when other costs, including the treatment of side effects, are considered.
Medicare has not put any restrictions on proton therapy. And Medicare pays much more for the treatment than it pays for standard radiation therapy.
“That’s the problem with Medicare payment policy,” says Harvard’s Chandra, “it not only covers treatments that are dubious treatments, it also covers dubious treatments extremely generously.”
But the doctors and researchers involved with building new proton beam facilities don’t think the treatment is dubious. They point to proton therapy’s potential to kill cancer without damaging surrounding tissue, and they say that it’s just a matter of time before clinical trials prove that proton therapy is worth the extra money.
Emory’s proton therapy center is expected to open in late 2016.
This article was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.
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