Proton Beam For Prostate Cancer: Study Says Lack Of Evidence Doesn’t Reduce Demand

In short

A new article about utilisation of an expensive, but technologically advanced treatment indirectly raises questions about the underpinnings of market-driven medical care. Reuters Health has published an article based on clinical trial findings relating to the adoption of proton beam therapy to treat prostate cancer in USA. The study is ostensibly about patient choice, concluding as it does that given the availability of the latest treatment, patients will choose it regardless of (lack of) clinical evidence.

Background

In a study published in Archives of Internal Medicine, February 13, 2012, researchers examined the treatment choices of nearly 20,000 men living inside or outside of a regional market for Loma Linda University, a hospital in Southern California with a proton beam facility. All men were diagnosed with low- to intermediate-risk prostate cancer between 2003 and 2006.

According to the report author about nine out of 10 of those cases were localised prostate cancer, meaning the cancer hasn’t spread outside the prostate gland. Nearly all men diagnosed with localised tumors survive at least five years after diagnosis.

Proton beam therapy is “touted” as a technological advancement over other forms of radiation therapy,  because it allows radiated particles to more tightly target and destroy tumour cells, leaving more of the surrounding tissue intact.

As a prostate therapy the treatment is often “billed” as having lower impotence and incontinence rates than other radiation options, “but there’s a lack of evidence to support this”, according to Dr. David Aaronson, a urologist at Kaiser Permanente Medical Group in Oakland, California, and lead author of the study.

In this study nearly nine percent of the patients living within the referral region for the facility received proton beam therapy, compared to less than two percent of patients throughout the rest of the state.

Evidence-base? No better and more expensive

Side-by-side comparisons of proton beam therapy and other prostate cancer treatments have not been done, according to Dr. Leonard Lichtenfeld, chief medical officer for the American Cancer Society.

Despite the added costs, there’s no evidence to suggest that proton beam therapy results in better outcomes than other forms of prostate cancer treatment, including other forms of radiation, surgery or hormone therapy.

Previous studies have estimated that proton beam therapy costs twice as much as intensity-modulated radiation therapy, another form of external radiation therapy and about five times more than radioactive seed implants.

Investigator comments

“Institutions with proton beam facilities often look to pad their numbers by treating prostate cancer”, according to Dr. Anthony Zietman, a radiation oncologist at Massachusetts General Hospital in Boston who was not involved in the new study.

“People often think that technology is synonymous with ‘better,’ but in some cases, it’s not,” said Aaronson.

“With the (US) healthcare crisis looming and multiple treatment options available, newer, more expensive procedures for prostate cancer should be validated before they are implemented,” he said.

“It’s not surprising that men are more likely to be treated with a certain technology in an area where that technology is offered,” Aaronson told Reuters Health.

We say

It’s a depressing reality that when market forces come into play the patient takes over in demanding certain treatments, especially when those treatments are seen as state-of-the-art. Maybe the FDA’s tough stance on new product introductions compared with CE marking, is justified by this fact alone in a sort of “we’re saving you from yourselves” way. But this is a weird situation isn’t it? “Proton beam therapy” has the ring of being the “must-have” accessory for every prostate cancer sufferer, yet is a rare sight in Europe. Does that mean we’re slow adopters or poor adopters. If the evidence is as thin as it sounds (and we’re no experts here) then slow must trump poor, especially in straitened times when cost restraint is a priority.

“After taking into account factors such as tumor stage and year of diagnosis, Aaronson’s team found that patients living near a proton beam facility were more than five times more likely to receive proton beam treatment than those living outside of the hospital’s referral region.”

Doesn’t this, however indirectly, point a rather accusing finger at the prescribing physician for not educating the patient about the lack of evidence… or indeed the facility with the expensive piece of kit waiting to be used.

Tell you what, let’s use proton beam therapy because it’s just down the road…it’s the latest technology so it must be good.

Source: Reuters Health