By Marion Davis
PROVIDENCE – A new study at Rhode Island Hospital has found that about one-third of cancer patients who now get radiation could get proton therapy, but that would boost treatment costs by one-fifth across the entire cancer population, or $1.3 million per year at that hospital alone.
Proton therapy is rapidly gaining ground as an alternative to standard radiation. The National Association for Proton Therapy calls it “the most precise and advanced form of radiation treatment today,” with minimal to no side effects, ideal for localized tumors.
Proton therapy is more precise than conventional radiation, so less healthy tissue is damaged. Therefore, the association says, proton therapy is “much more easily” tolerated.
But it’s also expensive. Dr. Tomas Dvorak, of the department of radiation oncology at Tufts Medical Center and Tufts University School of Medicine in Boston, and Dr. David E. Wazer, of the department of radiation oncology at Rhode Island Hospital and Brown University’s Warren Alpert Medical School, set out to quantify the difference.
The results of their study are published in the July edition of the Journal of the American College of Radiology, with the warning that “market-driven adoption of proton therapy into routine clinical practice may have a significant economic impact.”
Dvorak and Wazer reviewed the records of all patients treated with highly conformal photon radiation therapy – another high-precision approach – at Rhode Island Hospital between Jan. 1 and Dec. 31, 2007, using photon therapy as a substitute to estimate the proportion of patients who could potentially be treated with proton therapy.
The researchers categorized the treatment techniques using Medicare billing codes: conventional radiation therapy, intensity-modulated radiation therapy, Gamma Knife radiosurgery, stereotactic body radiation therapy and brachytherapy. Then they used the Medicare codes to estimate the cost difference if proton therapy had been used.
The 1,042 patients got 1,145 radiation treatment courses and 19,749 treatment fractions; highly conformal external-beam photon techniques were used in 31 percent of all fractions, with IMRT being by far the most common technology.
If those patients had gotten proton therapy instead, total radiation therapy costs at Rhode Island Hospital would have been 22 percent higher, the physicians estimated.
Because the study was limited to one hospital in one state, the authors warned that different Medicare reimbursement rates and patient mixes elsewhere might lead to different results. They plan to continue their research, delving deeper into which patients could really be good candidates for proton therapy.