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Greg, I agree that it will take time for insurance companies to see the long term benefit of proton radiation. I just wonder how long considering how long it has seemed to make it to us as a treatment? It really is too bad that insurance companies can have that much control over healthcare.
Hi, this is Melissa vanmeter, I work in the ambulatory float pool department and I really enjoyed these two articles.
1. Knowledge gained, I personally didn’t know that much about proton therapy before reading these articles so I learned quite a bit! Most interesting to me was that even though the 5 year survival was not statistically better, the side effects of proton therapy was so much less. It seems the quality of life is better for these patients with proton therapy.
2. Info gained will help me in my practice just knowing more about the differences between the two types of radiation. I would be able to answer a patients question now concerning the difference between the two.
3. The question I have after reading these articles is weather or not this proton therapy will be available for every site we traditionally radiate or will it only be certain areas?
Also I wonder about the cost. Does it cost more money? Will there be any reimbursement issues with insurance companies? 5 year survival wasn’t improved but there was a decrease in side effects. So insurance would save money in treatment of side effects but would that savings be enough for them to pay for the treatment if the cost is substantially more than the traditional therapy?Michelle, that’s a good point about how much the decrease in side effects of proton therapy could impact the nutritional status of the head and neck patients. If you consider that hydration, nutrition and potential hospital treatments and admissions to treat issues with these are costly then proton therapy could potentially keep patients out of the hospital.
Greg, I didn’t know that this proton therapy has been around that long.
That is very interesting. If OSU is just now adding it then I wonder how widely available it is in general nation wide?What was the knowledge gained from the article?
I learned what proton therapy is and how it can be beneficial for our cancer patients. I had never heard of it before and it sounds like a great option for our patients.
What other questions does the article raise about current practice?
The biggest question I have is what are we not using this therapy more often in our patients? That I know of, none of my patients that are candidates are using it or know about it. Do our providers know much about it? Maybe they need to be more informed as well.
Do you agree/disagree with the conclusions of the author, why?
One part I agree on is that the choice of proton therapy was usually determined by if patients’ insurance company approves it. That makes me think that there’s not enough research on proton therapy and the benefits.Megan, We currently do not use Proton therapy at the James. When I spoke to a doctor in the James radiation department, he told me it was money & reimbursement that causes the most hold up. He also said that patients need to meet certain criteria to have Proton therapy but every one is good for photon therapy. We are building another radiation department over off of Kenny road that I know will at least have 1 proton therapy vault. I can not wait to see what that brings for our patients.
Melissa, I believe a lot of the hold up is money & how expensive the actually machinery is. BUT if you can keep a patient out of the hospital during therapy, I feel insurance companies would jump on making things more accessible. Our health care system is not very good on being proactive for patients, they prefer to be reactive. Which in turns costs them more money, I believe.
What was the knowledge gained from the article?
I honestly didn’t know very much about proton therapy other than the James was going to add proton therapy for a treatment option in the new facility. I was interested in learning that the side effects are decreased with proton therapy and the amount of timing proton therapy lasts in the body is decreased. I was also interested in learning that proton therapy is more precise and able to treat harder to reach areas. This makes me excited for our oncology patients who experience a large amount of side effects from radiation and even more happy to hear pediatric patients can benefit.What other questions does the article raise about current practice?
My questions arise from what more data is needed to figure out if proton therapy can be more standard of care? The articles mention there is a lack of data to suggest in some cancers that proton therapy is beneficial. I’m wondering why? Precision and less side effects seem to be a good reason for me!Do you agree/disagree with the conclusions of the author, why?
I agree current research is needed to support proton therapy. It’s interesting that one article mentions ” two-thirds reduction in 90-day severe adverse events associated with unplanned hospitalizations” the cost savings in that alone seems worth investing in more research. Knowing OSU is adding proton therapy as an option gives me hope that maybe that more research is coming.Michelle, I agree the cost savings in hospital prevention is a huge benefit. Globally thinking about how hard high hospital capacity is hitting our oncology population at the James I will jump on the band wagon for anything to help hospitalizations.
Greg you mentioned insurance reimbursement. I wonder with OSU and NWCH radiation departments partnered if that will help keep patients who insurance will reimburse coming but at the same time maybe open OSU up to lead more clinical trails for other patients.
1. What was the knowledge gained from the article?
Proton therapy is more effective, better at hitting just the target, less side effects (less damage to surrounding tissue) and less hospitalizations. When I worked head and neck we would often refer to other facilities for proton therapy but I never gave it much though as to why. This was really informative for me.2. Will the research/information in this article change or influence your practice? Well, I would love for The James to offer this. Not sure why we don’t when it is that beneficial and we are supposed to be a leading cancer hospital. I am in gyn/onc and I am sure those patients would love having less side effects. I am going to ask why we don’t do this – I may ruffle some feathers but I am going to suggest referring out if it is better for the patient.
Do you agree/disagree with the conclusions of the author, why?
I completely agree. It’s a shame that we have this data but more is needed for insurance to readily approve. It is so disheartening that treatments are insurance and pharmacy driven rather than what is best for the patient. So, we need more research to support this for our patients.
Also, I would love to know the long term benefits – would there be less deficits from scarring since there should be less scarring. My gyn patients have life long unpleasant side effects to deal with, my head/neck patients often had to have their esophagus stretched because they would get tight and difficult to swallow.Greg, Kelly and Megan – you all mentioned insurance. I agree that care should be physician driven for the patients’ best interest. It is mind boggling how it works but as we have seen recently, seems the physicians have the last say in what treatment the patients should have.
kelly and Karafa.4 –
The head and neck population maybe would get through treatment not needing a feeding tube. I did mention that some patients would be referred out for this. Looking back, it seemed to be all one doctor referring out which raises a question if patients are good candidates but don’t get it because their physician’s facility does not offer it?Has anyone asked their physicians why we don’t order this (refer out) for patients more often?
1)What was the knowledge gained from the article? General knowledge of proton therapy and the benefits vs photon therapy. I look forward to when we start utilizing proton therapy in our new outpatient facility.
3)What other questions does the article raise about current practice? My biggest question is why aren’t we utilizing proton therapy treatment already? It has been around for a long time. We strive to be a leading research and cancer institute. I am very surprised we haven’t already adapted this as best practice, considering how much our patient’s suffer from photon therapy and concurrent chemotherapy.
4)Do you agree/disagree with the conclusions of the author, why?
I agree with the articles that more research is needed in this beneficial treatment. More data may show less toxicities, and lead to better patient outcomes, less medical interventions for side effects and intern better insurance coverage in the future.Hi! This is Holly Smith, Ambulatory JCRU.
Knowledge gained: Admittedly, I don’t know much, if anything about proton therapy, so this was very enlightening.
Influence practice: I am not sure yet, but look forward to seeing if it becomes a standard part of the treatment plans we offer at the James.
Questions raised: I read another article regarding the cost of proton therapy. The article discusses that people automatically assume the high cost of building the facility, equipment, etc will increase charges posed on patients for the proton therapy. It also discusses that Medicare sets the rate it will pay for the service including the facility, equipment, staff etc and private insurance companies individually negotiate with providers based on the rates Medicare sets for that facility. The rate for treatment is not based solely on the price tag of the center and equipment. Plus philanthropic donations, like the one the Mayo clinic received for their proton center, help to reduce the cost of developing proton centers. While in the beginning, proton therapy was more expensive, newer methods of delivery have reduced the number of treatments necessary, thus reducing costs. Furthermore, by targeting more specific areas, the breast for example, it reduces injury to heart/lungs, which also help reduce medical costs. Obviously, one cannot determine exact amount of cost reduction from decreased side effects and their treatment, but I would surmise it could be significant. Less side effects=less hospitalizations=less medical costs=higher quality of life. What price does one put on the quality of life? Will it actually increase treatment cost. I look forward to seeing how this all pans out.
Agree with authors’ consclusions: I do. Much more in the way of research needs to be done with regard to proton therapy.Megan,
Like you, I work in infusion so my knowledge of radiation is minimal. I agree that The James should have this type of therapy offered seeing at how effective it is according to research.
Abby
Mindy,
I agree that it is unfair for insurance companies the deny and determine what treatment a patient should or shouldn’t receive. Even after submitting countless evidence and reports, they can still deny treatment just because of the cost.
Who exactly at the insurance companies is making those decisions?Abby
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