Price of protons

Posted by on Thursday, August 27th, 2015

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With the cost of cancer treatment making constant headlines and hundreds of million of dollars being invested into new proton therapy centers around the world, it’s tempting to believe some experts who tout the cancer treatment as the latest contributor to healthcare’s skyrocketing costs.

That’s just not true, says Scott Warwick, vice president for strategic initiatives and program development for Provision Healthcare and chair of the National Association for Proton Therapy.

“People look at the cost of some proton therapy centers being built and assume because it’s so much more expensive to set up than conventional radiation that it is directly reflected in the cost to the patient,” he says. “That’s not exactly the way it works.”

The majority of proton therapy centers are freestanding rather than connected to medical centers. Medicare sets the rate it will pay for the service including the facility, equipment, personnel costs, supplies, geographic location, insurance and other direct and indirect expenses. It is not based solely on the price tag of the center and equipment. Private insurance companies individually negotiate with providers like Provision based on the rates Medicare sets for that facility.

Additionally, many of the centers receive significant philanthropic gifts to support the construction of the facility and purchase of the equipment. The Mayo Clinic, for example, received more than $100 million to support its new proton facility. This substantially reduces the cost to develop a proton therapy center.

And while initially proton therapy was more expensive than the conventional radiation it competed with, newer methods of delivering the therapy have reduced the number of treatments required and, thus, the cost of service.

Hypfractionation refers to the method of treating patients with the same prescribed dose of radiation with two-thirds to one-third treatments. Because of proton therapy’s ability to precisely target tumors with limited exposure to surrounding tissues, there are less side effects with treatment, which make it the ideal modality for hypofractionation.

For example, a study at MD Anderson Cancer Center showed a hypofractionated protocol for breast cancer cost $13,833 compared to the $19,599 cost of conventional radiation. Medicare reimbursement rates for hypofractionated treatment of prostate cancer show the cost of proton therapy at $26,050 with the cost of conventional radiation at a comparable $24,420. At Provision, prostate patients who choose hypfractionation cut their number of treatments from 39 to 20.

Harder to quantify are the cost savings from the reduced side effects and reduced radiation exposure proton therapy offers. For head and neck cancers, proton therapy reduces patient weight loss and the need for feeding tubes—factors that dramatically reduce the gap between proton and x-ray therapy, particularly toward the end of treatment. Proton therapy reduces the risk of pneumonitis, esophagitis, heart disease and secondary cancers due to radiation exposure for lung cancer patients. Recent studies show women treated for breast cancer using conventional radiation receive damaging doses to the heart and lungs. Pediatric patients see a long list of physical and neurological benefits from proton therapy.

Another MD Andersen study compared the cost of proton therapy and radiation in the case of patients with head and neck cancer, concluding the proton therapy cost just 6 percent more than intensity-modulated radiation therapy when taking into account the healthcare costs associated with weight loss, feeding tubes placement and resulting treatment re-planning and re-simulation because of greater side effects associated with IMRT.

This impact on a patient’s life after cancer is known as “quality-adjusted life years,” but Warwick agrees that’s difficult to quantify.

“It is difficult to put a price on improving someone’s quality of life,” he says. “It is a very inexact science and often varies in the eye of the beholder. It is easy to minimize having a feeding tube placed into your abdomen until you’re the one having the procedure performed.”

And yet, people—and their health insurance companies—are willing to pay for much costlier chemotherapy treatments to prolong life, if only for a few weeks or months. He cites an example of a drug for metastatic prostate cancer, shown to extend life on average by four months. The cost: $90,000.

“That’s double the cost or more for most proton therapy cases,” he says. “And this drug receives robust coverage from most commercial insurance payers, even though it is not even used to cure the cancer.”

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Kentucky patients flock to Provision

Posted by on Friday, August 14th, 2015

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A growing number of Kentuckians are coming to Provision Healthcare for cancer treatment and leaving as advocates of proton therapy in their home state.

More than 20 patients from the Bluegrass State have completed treatment at the Provision Center for Proton Therapy, and the state serves as one of the largest sources of patients next to Provision’s home state of Tennessee. Patients have come to receive treatment for prostate, breast and lung cancer and lymphoma and have included two pediatric patients suffering from brain tumors.

Proton therapy, for me, was a wonderful discovery,” said Glenn Ross, owner of Investment His Way in Elizabethtown, Ky. “I would absolutely recommend proton therapy to anyone diagnosed with cancer.”

After completing treatment for prostate cancer in June, Ross returned home determined to spread the word across the state, sending a release out to Rotary clubs statewide and setting up a support group for proton therapy patients. He has three presentations on proton therapy scheduled so far.

He’s joined by Richard Sutherland, a fellow prostate cancer sufferer with whom he played golf—six rounds in seven days—and marveled at the minimal side effects they suffered while in proton therapy.

“I’ve got 15 or more friends who have had surgery or conventional radiation for prostate cancer, and I was aware of all the side effects they experienced,” Sutherland said. “Then I started reading about proton therapy. I contacted about 25 patients who had the treatment, and every one of them had the conviction that they did the right thing. During my treatment I played a lot of golf. I ate a lot of good food. And I had very few side effects.”

Richard Sutherland & Glenn Ross

Sutherland, a principal of Frankfurt-based Stantec Consulting, an engineering firm that designs transportation projects throughout the U.S.—Sutherland oversees its Kentucky projects—said he is also looking for opportunities to spread the word about Provision.

“I’d shout about it from the mountain-tops if I could,” he said. “Proton therapy is just little known among the population.”

Eleven-year-old Emma Ferrell of Winchester, Ky., found proton therapy to be a relief after enduring both regular and high dose rounds of chemotherapy for a brain tumor.

“It was pretty wonderful,” says Linda Ferrell, Emma’s mother. “Emma’s been through quite a bit over the last year. With the treatment at Provision, it was pretty easy. I’m a huge advocate for proton therapy.”

Emma and her mother were able to stay at the local Ronald McDonald house and, when Emma felt up to it, enjoyed trips to the zoo, the mall and a local herb garden.

For Lydia P., the trip Provision Center for Proton Therapy offered hope as her son Philip—after three surgeries and an unsuccessful immunotherapy treatment in Germany—continues his battle with stage 4 brain cancer.

“I prayed and said, ‘It’s got to be quick and it’s got to be covered (by insurance),” she says. “For me, it’s just the hope that he’s going to live and that he’ll have two-thirds less of his brain that’s irradiated.”

And the experience at Provision provided a place of refuge in a most difficult situation, Lydia says.

“It’s unusual that you have a group of people that care so much about the patients,” she says.

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Crowdfunding becomes source of support for those with life-threatening illnesses

Posted by on Friday, August 7th, 2015

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It has not exactly been a banner year for Holly Caster.

Forced by an auto accident to leave her job and in the wake of related health problems, she noticed a nagging toothache that wouldn’t go away.

A visit to the dentist revealed a filling had been shoved up into her gum, but even after he fixed the tooth “the pain just go worse and worse,” she says.

She made the rounds of her dentist, an oral surgeon and ear, nose and throat specialists before a doctor told his nurse: “She needs a CT scan, now.”

They found adenoid cystic carcinoma, an uncommon form of oral cancer. Resulting surgery removed 70 percent of her left parotid or salivary gland and stripped the facial nerve to which a 2.4-centimeter tumor had been attached.

The good news: the cancer had not spread. However, to eliminate this risk, radiation therapy and chemotherapy were recommended. Because of the location of the cancer, conventional radiation typically results in a feeding tube and other unpleasant short- and long-term side effects. That made proton therapy the recommended route but required Caster to travel from Michigan to the Provision Center for Proton Therapy for treatment.

Fortunately, insurance approved the treatment, but the process has been disruptive. Caster, her sister, mom and kids have set up housekeeping in Knoxville for the more than two months she’ll be here for proton therapy combined with a chemotherapy course. That means financial stress on top of everything else.

But like many who find themselves in similar circumstances, Caster has received assistance from family, friends and friends of friends through the crowdfunding site, gofundme.com. (Her page is http://www.gofundme.com/xjrgf7c.)

Apple Wick set up the site for Caster, who describes her as “more than a best friend.” So far, the site has raised $3,100 for her cause.

Although the first known Provision patient to seek support by way of fundraising online, there has been a significant uptick in crowdfunding for healthcare expenses, with a number of sites starting up to fill the niche. Among them GiveForward, Healthline, FundRazr and StartACure, which focuses specifically on medical research work.

On the GoFundMe site, individuals in 2014 raised $147 million from about 600,000 appeals in the “Medical, Illness and Healing” category and 2014, so far in 2015, has hosted more than 740,000 medical appeals raising more than $197 million, according to a recent news article in The Buffalo News.

Proton therapy candidates are among those who may especially benefit from these campaigns. Because many private insurers don’t cover the treatment, patients may face paying for it out of their own pockets. A GoFundMe search returned 153 proton therapy-related pitches, ranging from a $247,000 campaign for a young Filipino girl with spinal cancer to $6,185 for the travel expenses of a family whose baby was diagnosed with a brain tumor. 

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Auto enthusiasts support Provision patient with surprise car show

Posted by on Wednesday, August 5th, 2015

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When Philip P. arrived at the Provision Center for Proton Therapy for his last treatment and graduation ceremony, he got more than he bargained for.

Ninety Corvettes, sports cars and hot rods filled the parking lot as more than 200 people from the East Tennessee Corvette Club and its sponsor, Reeder Chevrolet, responded to the call to give Philip, a car lover—of Corvettes especially—his own personal car show.

The 13-year-old from Kentucky, who is suffering from stage 4 brain cancer, made his way with two of his brothers around the lot, sitting in each car and taking a few joy rides.

The event was pulled together quickly, with the help of Provision’s Proton Ambassadors Vince Sica and Joe Hamby (the second patient to be treated at Provision), former ambassador Tom Zuraf and Jerry McDaniel, fixed operations director for Reeder Chevrolet.

McDaniel said he came back from vacation to find an email recruiting Corvette owners for the event—but just three or four had signed up.

“We weren’t getting a response, because it was happening in only a week,” Sica said.

McDaniel went to work, sending out emails to club members, and in the end more than 30 cars showed up. So did an additional 60 autos including a Porsche, two Lamborghinis and various hot rod and muscle cars.

“Considering we had a week to put it together, it worked out very very well, and, most important thing was we gave the young man a great experience to remember,” says Hamby.

McDaniel also went to work on giveaways, and club members donated a trunk full of memorabilia including signed Nascar items, model cars, books and a large collection of hats.

“That made his day,” Hamby said.

That evening, the Corvette club held its monthly meeting, where Sica thanked those who participated in the Provision car show.

“They were all personally, personally touched with the family camaraderie here (at Provision) and the closeness with Philip,” Sica said.

For McDaniel, it was also an opportunity to support proton therapy, something he has become an advocate of through his relationship with Zuraf who was treated with proton therapy and is McDaniel’s neighbor.

“The way Tom has explained proton therapy process, I guess I would say I’m a pretty good advocate of that myself,” he said.

Auto enthusiasts support Prfovision patient

 

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