(This article has been updated with a correction.)
Widespread construction of expensive proton-beam therapy centers is galloping ahead, despite warnings from insurers and policy experts who decry the lack of evidence proving that the costly treatment produces better outcomes in prostate cancer patients, its most frequent use.
At least a dozen new facilities, which can cost more than $200 million each to build, are on the drawing board or under construction. Their completion would nearly double the number of proton centers in the U.S. Advocates of the technology say proton-beam therapy spares healthy tissue and can improve a patient's quality of life and overall outcomes. But the procedure can cost twice as much as traditional radiation treatment. Critics say that financial incentives may be encouraging hospitals and companies to invest in the facilities and push patients toward proton-beam therapy when less costly and equally effective treatments are readily available.
“I view proton-beam therapy as ground zero to look at whether we're going to bend the cost curve,” said Amitabh Chandra, director of health policy research at the Harvard Kennedy School of Government. “It's very hard to spot waste in healthcare. Proton therapy is an example of waste you can spot right away.”
Although Loma Linda (Calif.) University Medical Center opened the nation's first proton center in 1990, only in the past decade has it become more widely used for treating prostate cancer, as well as cancers of the lung, breast, head and neck, and pediatric cancers.
Hospitals and proton centers, well aware of skepticism, are seeking to research and quantify the benefits of proton-beam use in prostate cancer patients. Proponents say the technology eradicates tumors more effectively and has fewer side effects such as incontinence or impotence, which frequently affect men receiving more traditional radiation therapies. To prove those benefits, these providers are participating in prospective clinical trials, developing registries and conducting research to address questions from patients and insurers about the quality and costs of proton-beam therapy.
“Part of the challenge is that there hasn't been a lot of clinical evidence to promote proton therapy,” said Stuart Klein, executive director of the University of Florida Proton Therapy Institute in Jacksonville, which opened in 2006. “As time goes on, the level of clinical evidence is going to increase.”