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February 15, 2012

Medical journal critical of proton beam therapy

Here's an interesting take on proton beam therapy that originated in the Archives of Internal Medicine journal.
02152012protonbeamtherapy
This was spotlighted on Valentine's Day by Gary Schwitzer on the Health News Review blog. Health News Review is a non-profit group focused on keeping an eye on how health  news is reported in the media.
 
While Mayo Clinic's massive proton beam projects in Rochester and in Arizona were not mentioned, this does seem to follow the same lines of thinking from the New York Times editorial. It is worth noting that the NYT editorial was written by doctors whose medical centers already offer proton beam therapy.

It seems this technology, which is surprisingly constroversial, is becoming a competitive issue among hospitals and other "medical destination communities."

Here's some from Schwitzer's post on this topic:

A "research letter" in the Archives of Internal Medicine this week concludes:

“To our knowledge, we show for the first time that the availability of a technology, in this instance a proton beam facility, in one’s HRR (hospital referral region*) is associated with a higher likelihood of receiving proton beam therapy compared with those living in an HRR where this technology is not available.”

* The Dartmouth Atlas defines HRR this way: “Hospital service areas make clear the patterns of use of local hospitals. A significant proportion of care, however, is provided by referral hospitals that serve a larger region. Hospital referral regions were defined in this Atlas by documenting where patients were referred for major cardiovascular surgical procedures and for neurosurgery.

The authors write:

“The number of treatment options for localized prostate cancer continues to expand, amidst growing concern regarding overdiagnosis and overtreatment of low-risk disease.  Treatment patterns, however, may be driven by availability of novel Mayo Proton Center - Rochester Exterior 09.13.10technologies rather than by clinical indications.

---------

No prostate cancer treatment has been proven superior to the others. There are, however, substantial differences in cost, which are becoming more important to society and are a focus of health care reform in the United States.While there are theoretical advantages to proton beam therapy from a radiation physics standpoint, no study yet has demonstrated its superiority to modern photon-based therapy in terms of either oncologic or quality of life outcomes…

Proton beam therapy has not been shown to be superior to other treatments for prostate cancer and is substantially more expensive.Caution should be taken when considering implementation of this technology in additional regions, which may lead to greater use of this technology.”

Comments

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Proton beam therapy seems to be more targeted that other treatments. It is being used over here in the UK. The fact that it can be localised sets it a little way appart form other treatments.

The three founding principles of Mayo Clinic are Practice, Education and Research. You can see this embodied in anything that carries the Mayo three shield logo. The authors argue that proton beam therapy has not been proven via empirical study. Wouldn't it make sense then that Mayo Clinic, a leading research hospital, would build a facility like this? I do not see the article as being critical of Mayo, but rather of hospitals that are building these facilities with no intention of using them for research.

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