Does United Healthcare Cover Proton Therapy?

Does United Healthcare Cover Proton Therapy
CNN — A federal judge blasted UnitedHealthcare last month for its “immoral and barbaric” denials of treatment for cancer patients. He made the comments in recusing himself from hearing a class-action lawsuit because of his own cancer battle – and in so doing thrust himself into a heated debate in the oncology world.

At issue is a treatment known as proton beam therapy, an expensive alternative to standard radiation that proponents say is a more precise form of treatment with fewer side effects.
Opponents have questioned whether proton therapy is worth the high cost to fight some forms of cancer, and insurance companies have often denied coverage for the treatment, calling it “experimental.” The case that came before US District Judge Robert N.

Scola was brought by a prostate cancer survivor who alleged that UnitedHealthcare wrongfully denied him and thousands of others coverage of proton beam therapy. In his recusal, Scola cited his own battle with prostate cancer and how he consulted “with top medical experts around the country” about treatment options.

Scola said that he ultimately opted for surgery but that “all the experts opined that if I opted for radiation treatment, proton radiation was by far the wiser course of action.” The judge also cited a friend who was diagnosed with cancer in 2015 and got hit with a $150,000 bill after UnitedHealthcare refused to pay for his proton beam radiation from MD Anderson Cancer Center.

“Only upon threat of litigation did UnitedHealthcare agree to reimburse him,” Scola wrote. “It is undisputed among legitimate medical experts that proton radiation therapy is not experimental and causes much less collateral damage than traditional radiation,” wrote Scola, a US District Court judge for the Southern District of Florida.

To deny a patient this treatment, if it is available, is immoral and barbaric.” UnitedHealthcare declined to comment about the remarks.
Instead, the insurer noted that it updated its policies in January to allow more coverage of proton beam therapy for various cancers.
In a major shift on prostate cancer specifically, the company said proton beam radiation and traditional radiation “are proven and considered clinically equivalent for treating prostate cancer.” “UnitedHealthcare works every day to ensure our members have access to proven, clinically effective care,” spokesman Matthew Wiggin said.

“We cover cancer therapies that have been clinically proven to be safe and effective, including, for some cancers, proton beam therapy. Our medical policies and coverage decisions evolve based on the most current published clinical and scientific evidence and we continually review and update these polices and coverage decisions.” The judge’s comments were widely shared among patients and doctors who have felt stiffed by the nation’s largest insurance company.

But whether he intended it or not, they stirred controversy beyond social media. The American Society for Radiation Oncology, or ASTRO, the largest organization of doctors who use radiation to treat cancer, acknowledged that the issue is one that stokes passion. Proton beam therapy can cost 60% more than standard radiation, even well over $100,000.

“The reason protons are controversial is for two reasons: because of the costs and the access,” said Dr. William Hartsell, ASTRO’s vice chairman for health policy. “I think if protons were more available and less expensive, there are a lot more patients who would get treated with protons.” Proton therapy targets difficult-to-treat tumors and allows for a higher dose of radiation to hit the targeted area, minimizing damage to other tissue, including vital organs.

Standard radiation radiates the areas around a tumor rather than a pinpointed location. “We keep improving technology to do that better and better,” Hartsell said. “So proton beam therapy is the next step.” ASTRO updated its guidance for insurers in the summer of 2017 with a host of cancers that the organization now believes could be treated with proton beam therapy and should be covered by insurance.

The guidance replaced research published in 2012 that had found evidence was lacking for proton therapy in certain cancers, including lung cancer and head-and-neck cancer. There are 31 proton beam centers in the nation and four more under construction, with the sites costing $100 million to $250 million depending on the size of the facilities, according to ASTRO.

Hartsell said the 2012 research was based on information from 2009, when only five proton centers existed.
There’s been a huge change in the number of studies and amount of information since then,” Hartsell said.
But I don’t think everybody’s kept up on that.” That includes insurance companies.
Hartsell said a recent study showed that about two-thirds of cancer patients were initially denied proton treatment by their insurers: “If you have a patient, say with esophageal cancer, they can’t wait four months for a decision on treatment.” “One of the problems we have right now with these policies is, they are a one-size-fits-all policy,” he said.

“They’re kind of removing the medical judgment of the people who are in the best position to make that decision.” He applauded UnitedHealthcare’s recent decision to cover proton beam for prostate cancer when appropriate. Two studies are ongoing to determine its effectiveness for prostate cancer, he said.

In its 2017 guidance, ASTRO said proton beam’s use in prostate cancer is still “evolving as the comparative efficacy evidence is still being developed.” And therein lies the rub among some doctors about the judge’s comments: Treatment for localized prostate cancer remains a research question. “The judge is wrong.

He does not know the facts, and he has fallen for some of the advertising,” said Dr. Otis Brawley, a professor of oncology at Johns Hopkins University’s School of Medicine and the former chief medical officer at the American Cancer Society. Brawley, who still sees prostate cancer patients, said the physics “of proton beam radiation therapy would suggest that it might have less side effects compared to conventional external beam radiation (IMRT) in the treatment of a number of diseases, including in the treatment of localized prostate cancer.” “This said, there is currently no evidence that proton beam radiation therapy offers any advantages over IMRT in the treatment of prostate cancer,” he said.

The federal judge made his comments in response to a class-action lawsuit brought by Richard Cole, a cancer survivor and prominent Miami attorney.
Cole was 70 when he was diagnosed with advanced prostate cancer in April 2018.
The first concern you have is: Am I going to die?” Cole said.
He said he consulted with his team of doctors at the Miami Cancer Institute and with others at the Memorial Sloan Kettering Cancer Center in New York.

The consensus, he said, was that he needed proton beam therapy. But he said he soon learned his treatment was being delayed because UnitedHealthcare refused to cover it. He paid the $85,000 out-of-pocket to undergo treatment as soon as possible while his attorneys appealed his denial.

When delays occur because of bureaucracy,” Cole said, “it gets you angry and upset.” His final appeal was denied in February, he said, even though UnitedHealthcare updated its policy a month before to allow coverage for prostate cancer.
That policy change, he said, was the “proof in the pudding” that the lawsuit will hold up in court.

“How can you now change your position with no new studies and look at a jury or a judge with a straight face and say ‘this man’s cancer and many other people’s cancer shouldn’t be treated exactly that way’?” he asked. His suit also alleged that a subsidiary of the insurance giant has invested heavily in a proton center in New York.

If his case prevails, Cole said, he will donate any monetary award to the Miami Cancer Institute. “I certainly know that not many people can write a check for $85,000, and they shouldn’t be foreclosed from getting the right treatment just because they don’t have the available funds,” said Cole, who has defended insurance companies – just not health ones – in his line of work as an attorney.

His most recent lab results showed that he is clinically cancer-free. He attributes his good health to his team of doctors and to proton beam therapy. He now wants more Americans to have access to the treatment. His next major hurdle may be finding a judge who will preside over the case.

Does UnitedHealthcare pay for proton therapy?

Judge recuses himself from UnitedHealthcare proton therapy lawsuits At least two lawsuits have been filed against UnitedHealthcare in the last two months alleging the insurance company improperly denied patients coverage for a certain type of cancer treatment that insurers have long been reluctant to pay for.

On Monday, U.S.
District Judge Robert Scola recused himself from deciding one of the lawsuits filed this month in Miami because of personal experience with the cancer treatment, writing in an order of recusal that denying a patient the treatment “is immoral and barbaric.” “It is undisputed among legitimate medical experts that proton radiation therapy is not experimental and causes much less collateral damage than traditional radiation,” Scola wrote.

“To deny a patient this treatment, if it is available, is immoral and barbaric.” The treatment, called proton beam therapy, is a radiation therapy used by oncologists to kill cancerous tumors. Compared with traditional radiation, proton therapy is used to target a specific site on the body, limiting damage to surrounding tissues.

According to the complaints, UnitedHealthcare denied coverage for the proton beam therapy for one patient’s prostate cancer and another patient’s cervical cancer, in both instances determining that the treatment is experimental and unproven.
But the patients, who are seeking class action status for their lawsuits, argue that proton therapy is a decades-old effective and established cancer treatment.

It was approved by the Food and Drug Administration in 1988 and is paid for by Medicare, according to the complaints. “Instead of acting solely in the interests of the participants and beneficiaries of its health insurance plans, upon information and belief, UHC denied coverage for PBRT to treat prostate cancer because, on average, PBRT is significantly more expensive than traditional Intensity Modulated Radiotherapy or other treatments,” one complaint alleged.

UnitedHealthcare said Monday that it “bases its medical policies and coverage decisions—including for proton beam therapy—on the prevailing published clinical and scientific evidence.” UnitedHealth isn’t the only insurer that has denied coverage of proton beam therapy for certain cancers. Last year, an Oklahoma jury told Aetna to after the insurer denied to pay for the treatment based on grounds that it was experimental.

Other insurers and policy experts have that there’s a lack of evidence showing proton therapy produces better outcomes than other types of radiation. Despite that, hospitals and other companies have proton-beam therapy centers. Richard Cole, the plaintiff in the amended complaint filed last week in a federal district court in Miami, was diagnosed with prostate cancer in April 2018 and his physicians at Baptist Health South Florida recommended proton therapy as an alternative to another type of radiation called intensity modulated radiation therapy, or IMRT, because of the likelihood of a better health outcome, according to the complaint.

UnitedHealthcare, which administered medical benefits on behalf of Cole’s self-funded employer, denied his prior authorization request and subsequent appeals for coverage of proton therapy on the grounds that it fell under an exclusion for experimental, investigational or unproven services for patients over 19 years old.

Cole paid for the treatment out of pocket. UnitedHealthcare then changed its policy effective Jan.1, 2019, to cover proton beam therapy for prostate cancer, acknowledging that proton therapy and IMRT are “proven and considered clinically equivalent for treating prostate cancer,” the complaint stated.

Still, UnitedHealthcare’s independent reviewer continued to deny Cole coverage of the treatment as recently as February 2019. In the other case filed in March, patient Kate Weissmann, whose employer contracted with UnitedHeathcare for benefits administration, similarly alleged that the insurer repeatedly denied coverage for proton therapy to treat her cervical cancer in 2016 based on a policy that relied on “outdated medical evidence, ignores contemporary medical evidence, and relies more heavily on actuarial calculation of risk pools” because it covers the therapy for patients younger than 19 and older than 65.

She also alleged that UnitedHealthcare relies on an “inadequate review of clinical records” by medical directors who are unqualified to make coverage determinations. The insurer denied coverage despite recommendations by her physicians at Mass General and the Dana-Farber Cancer Institute that proton therapy was essential for Weissman’s treatment for reasons including IMRT put her at risk for bowel and gastrointestinal toxicity while proton therapy reduced that risk.

Weissman shelled out $95,000 out of pocket for proton therapy. The complaints do not state how many patients might be affected by UnitedHealthcare’s coverage policy for proton beam therapy. However, the lawsuit filed in Miami noted that 5,000 patients within prostate cancer were treated using proton therapy nationwide in 2018.

Judge Scola wrote in his recusal order that UnitedHealthcare denied coverage of proton radiation treatment requested by his close friend in 2015. UnitedHealthcare agreed to pay for the $150,000 treatment when threatened with litigation. The judge also wrote that he personally was diagnosed with prostate cancer in 2017 and the experts he consulted throughout the country determined that proton therapy was the “wiser course of action” if he opted for radiation.

What insurance pays for proton therapy?

Cost of Proton Therapy – Oklahoma Proton Center We often get asked questions by prospective patients and other physicians about the cost of proton therapy. Is it expensive? Does insurance cover it? How much is it if insurance doesn’t pay? All of these are important questions worth addressing. Does Insurance Cover Proton Therapy? Does United Healthcare Cover Proton Therapy All of the major insurance companies cover proton therapy treatment. This list includes Blue Cross, UnitedHealthcare, Aetna, Cigna, Humana, TriCare, and many more. Additionally, Medicare and Medicare Replacement plans offer broad coverage for proton therapy.

The coverage offered by commercial payers can vary depending upon the payer and the patient’s specific insurance plan. At Oklahoma Proton Center, nearly 80% of patients with commercial insurance that request authorization get approved by their insurance plan for treatment at the facility. We work with each patient prior to treatment to determine what their benefits will be for their diagnosis and treatment regimen.

We are required by law to provide a Good Faith Estimate of what the cost to the patient will be. Medicare approves treatment for proton therapy at Oklahoma Proton Center; thus, patients with Medicare can be confident that their treatment will be paid for.

By law, Medicare Replacement plans have to offer the same coverage as Medicare, so patients with these plans will also have coverage, although a referral may be required. How much does proton therapy cost? As is often the case in healthcare, the answer is it depends. It depends on what your doctor prescribes in terms of how many treatments it will take to treat your disease.

It will depend on your particular insurance plan. Medicare pays about $1,000 per treatment thus if a patient has a 20% co-pay, they would owe about $200 per treatment. A patient may receive anywhere from 5 to 44 treatments which is why the answer is, “it depends.” There are some additional ancillary charges related to the cost of the physician, imaging to prepare the patient for treatment as well as routine imaging during treatment, developing your custom treatment plan, etc.

If a patient does not have insurance, Oklahoma Proton Center offers cash pay rates that are the lowest in the industry.
Oklahoma Proton Center is a not-for-profit healthcare provider that also offers a charitable care policy as part of its original charter.
The center can provide need-based discounts or grants as well as structure payment plans that can help patients afford treatment.

We do not want the cost of treatment to be a burden that prevents patients from receiving the care that they need. Does United Healthcare Cover Proton Therapy Is proton therapy more expensive than other treatment options? This depends on a number of factors, including where the other treatment is being provided and what treatment or treatments are being included. For example, Oklahoma Proton Center is a free-standing, independent facility, so the cost of proton therapy here can actually be less than traditional radiation treatment at a hospital that charges much higher rates.

Chemotherapy, Immunotherapy, and other targeted therapies can often cost into the hundreds of thousands of dollars. The cost of a course of proton therapy at Oklahoma Proton Center can range from between $25,000 to over $100,000, once again depending on the answers to the question above regarding the number of treatments and the particular insurance plan of the patient.

But still, much less expensive than some of of the other treatment modalities used to treat cancer. Additionally, the “cost” burden of treatment isn’t just the cost of the treatment itself but also the cost of treating the side effects of the treatment. Does United Healthcare Cover Proton Therapy In fact, a study from MD Anderson did in conjunction with the State of Texas employee health benefit plan showed that over a 6-month period, the total cost of caring for a proton therapy patient was less than the cost for a comparable patient receiving IMRT (photon-based radiation treatment).

This was due to the reduction in treatment related complications for the proton therapy patients. What else should I know? Ultimately what is most important is that a patient receives the best possible treatment regardless of where that is or what that is, or what the cost is. That is why it is so important for patients to be their own advocates and do their research.

A physician consultation is almost always covered by insurance and only takes an hour or two out of one’s day. A very small investment in what could be a life-changing decision. Every patient should explore all possible treatment options before making a decision.

Does insurance cover proton radiation therapy?

We know patients have many questions when making decisions about cancer care. The cancer specialists at MD Anderson Proton Therapy Center are here to offer answers, support, help and hope. Our experienced team offers patients a partner and a roadmap for the most advanced care available in a compassionate, caring environment.

What is proton therapy? How is proton radiation different from traditional photon radiation? Why should I choose MD Anderson Proton Therapy Center? Is proton therapy experimental? What types of cancer are treated with proton therapy? How is proton therapy planned and delivered? What happens during treatment? How long does the radiation remain in my body? Is proton therapy ever combined with other forms of cancer treatment? Can children receive proton therapy? Do I need a doctor’s referral for the Proton Therapy Center? Are there support groups for people undergoing proton therapy? Does insurance cover proton therapy? What if I don’t have insurance but want proton therapy? Is there a long wait for a consultation or appointments?

What is proton therapy? Proton therapy is a form of external beam therapy for which powerful equipment is used to generate beams that penetrate the body. Oncologists use proton therapy to precisely deliver high doses of radiation to a tumor to kill the cancerous tissues without damaging surrounding healthy tissues.

Learn more about proton therapy How is proton radiation different from traditional photon radiation? In traditional radiation therapy, X-ray beams are typically used to treat cancer. The X-ray beams go through the cancerous tissue (tumor) destroying both healthy and cancerous areas along the path of the beam.

Proton beams enter the body and deposit most of their energy at the target – the site of the tumor. Radiation oncology physicians are able to focus the energy of the proton beam within a tumor, minimizing damage to nearby healthy tissues and vital organs.

Advanced radiation therapy with treatment for the most comprehensive range of cancers Reduced side effects and minimal damage to healthy tissue Access to MD Anderson Cancer Center’s world-renowned research, cancer specialists and multidisciplinary care A caring, comfortable environment that is easy to access with free surface-level parking

Is proton therapy experimental? No, proton therapy is neither experimental nor investigational. It has been used in the United States for more than 50 years and in a hospital setting since 1990. It is an established form of treatment that is widely accepted by physicians, government agencies and many insurers.

What types of cancer are treated with proton therapy? Proton therapy benefits patients whose tumors are solid with defined borders, meaning that the cancer has not spread to other parts of the body.
The MD Anderson Proton Therapy Center provides the most advanced radiation therapy available to treat cancers of the prostate, lung, liver, esophagus, brain, and lymphoma.

Pediatric cancers such as sarcomas and cancers of the central nervous system such as brain tumors, as well as other rare tumors can also benefit from proton therapy. The team at MD Anderson Proton Therapy Center has a deep level of expertise in cancer and in the research and treatment of cancer with proton therapy.

Because of this, we have been able to expand the areas treated with proton therapy to benefit even more patients who are fighting cancer.
Learn more about the types of cancer treated with proton therapy How is proton therapy planned and delivered? After an initial consultation with a radiation doctor and radiation oncology nurse, patients undergo a simulation.

The simulation is a treatment planning session during which the simulation team marks the specific areas where you will be treated during your proton therapy treatments. Proton therapy treatments usually begin five to 10 business days after the simulation procedure and continue daily, Monday through Friday, for up to eight weeks.

The length of treatment varies depending on the type of cancer. Your health care team will be able to tell you exactly how many treatments you will need after your consultation. Learn more about what to expect What happens during treatment? In the treatment room, the radiation therapist will position you and use the markings from your simulation procedure to deliver your prescribed proton therapy dose accurately.

During your treatment, the radiation therapist will remain in the control room where he or she can see and talk to you at all times by closed circuit television and two-way intercom. Proton therapy treatment is painless, and most patients continue to work and exercise during and just after treatment.

How long does the radiation remain in my body? Proton radiation, once delivered to the targeted tumor site, has a very short life. After you complete treatment, you can leave the treatment room without any risk or radiation exposure to others. Is proton therapy ever combined with other forms of cancer treatment? Yes.

Many times lung cancer, pediatric cancers and lymphomas are treated with other types of therapy as well as proton therapy. Depending on the case and type of cancer, proton therapy may be used in combination with traditional radiation therapy, chemotherapy and surgery.

If your type of cancer can best be treated with combination therapy, your doctor will discuss this in detail with you. Can children receive proton therapy? Yes. The ability to precisely target tumors makes proton therapy ideal for treating childhood cancer. It provides accurate treatment of tumors near or within sensitive organs while limiting radiation exposure to healthy tissues, which is vital in children whose bodies are still growing and developing.

This may reduce side effects during treatment, often allowing children to better tolerate proton therapy. Tumors in children that can benefit most from proton therapy are tumors of the brain, head, neck, spinal cord, heart or lungs. Learn more about the types of pediatric cancers treated with proton therapy Do I need a doctor’s referral for the Proton Therapy Center? No.

Call toll-free: 1-866-632-4PTC or 1-866-632-4782 Request an appointment online

Are there support groups for people undergoing proton therapy? Yes, MD Anderson Proton Therapy Center holds patient support groups on a regular basis in our facility. Your nurse or member of your treatment team can give you the most current schedule. Additionally, ProtonPals, an online support group, is available for people who are considering proton therapy, currently in treatment or who have had proton therapy treatment at MD Anderson,

Does insurance cover proton therapy? Proton therapy is covered in the United States by Medicare and many insurance providers. MD Anderson Proton Therapy Center accepts several major insurance plans as well as Medicare and Medicaid. Our patient access specialists can work with your insurance carrier to define your benefits.

What if I don’t have insurance but want proton therapy? The Proton Therapy Center staff is experienced in working with patients both domestically and internationally who are interested in making arrangements to pay for their care directly. To talk with a member of our team, please call 1-866-632-4782 or send us an e-mail,

Is proton beam therapy free in UK?

Where is it available? –

There is a low energy proton machine in Clatterbridge which treats some eye cancers.The rest of this page is about high energy proton beam therapy which is used to treat some other types of cancer.Up until recently everyone needing high energy proton beam therapy had to go abroad for treatment.

In 2009, the UK government made the decision to set up a National NHS Proton Beam Therapy Service. Currently there is one centre at The Christie NHS Foundation Trust in Manchester, offering high energy proton beam treatment for anyone needing it in the UK.

In 2021, another centre will open at University College London Hospital (UCLH). It will take a while for both these centres to be fully up and running. So some people will still need to travel abroad for treatment for the next couple of years. Proton beam therapy is also available in private treatment centres in the UK.

So you would have to pay for this treatment or use private insurance if you have it. A small number of people in South Wales may have proton beam therapy on the NHS at the Rutherford Cancer Centre. This is a private treatment centre in Newport. You have the PBT there and the rest of your care is at your usual cancer treatment centre.

How much does proton therapy cost UK?

Where to access Proton therapy

Where to get Proton Beam Therapy (PBT) for Prostate cancer currently means going privately in the UK. Very sadly as of 7th JUNE 2022 Rutherford announced it is going into administration. In the hope that the clinics may yet be bought out of administration we are for the moment leaving the contact information in place. There will be only 2 NHS centres providing high energy PBT in the UK, The Christie NHS Foundation Trust in Manchester, and University College Hospital NHS Trust (UCLH) in London. The Christie NHS proton beam therapy centre opened in Autumn 2018, and the first patient was treated in December 2018.The second NHS centre is at University College London Hospitals with which opened in summer 2020.

PBT is not currently available on the NHS for the Treatment of prostate cancer as it is not perceived as delivering better outcomes than Image Modulated Radiotherapy IMRT, but is far more expensive. Having said that, reported side effects from pencil beam PBT are less as nearby healthy tissue likely remains undamaged. Does United Healthcare Cover Proton Therapy Dr Reena DavdaConsultant Clinical Oncologist University College Hospitals London Dr Jason Lester Consultant Clinical Oncologist Singleton NHS Hospital Swansea Dr Anita MitraConsultant Clinical Oncologist University College Hospitals London Costs for treatment in Prague, including living expenses are believed to be around £35,000. If the situation changes in terms of where to get Proton Beam Therapy (PBT) for prostate cancer, this page will be updated.

What is the average cost of proton therapy?

Wise Buy? Proton Beam Therapy On Feb.18, 2014, Scripps Health in San Diego issued a press release that “celebrated the opening of the Scripps Proton Therapy Center,” a $220 million facility to bring to southern Californians “one of the most advanced, accurate treatments available for cancer care.” It sounded like a weapon out of “Guardians of the Galaxy”: A 95-ton superconducting cyclotron would use hydrogen and oxygen to create a plasma stream.

Protons would be extracted from the plasma and accelerated to a speed of 100,000 miles per second. A beam-transport system would direct the proton stream to different treatment rooms, blasting tumors of the prostate, head and neck, breast, spine, lung and gastrointestinal tract, and many childhood cancers.

For those less intrigued by the technical details, the release touted the center’s “modular stone walls and wood and tile design accents” intended to “provide a comforting, emotionally supportive environment for healing.” Proton therapy, you might reasonably conclude, was the best thing to hit San Diego since sunshine.

Scripps and its two affiliates in the project – Rady Children’s Hospital and the University of California San Diego Health System – said they could care for up to 2,400 patients annually. Just after the center’s three-year anniversary, however, the sunny skies turned gloomy. The Scripps Proton Therapy Center filed for bankruptcy protection.

Whatever effect plasmas and protein beams might have on cancer, they were evidently not having the hoped-for effect on patients. Court documents said that since the center’s opening, it “has not operated on a profitable or even a break-even basis.” The Scripps center’s failure to attract patients mirrors a national trend.

At the 2016 annual meeting of the American Society for Radiation Oncology (ASTRO), researchers reported that the use of proton therapy was growing, but barely.
In 2012, 5,377 patients were treated.
That rose to just over 7,000 in 2015.
The number of cases of prostate cancer, the most commonly treated condition, was nearly unchanged at about 2,300 cases annually.

(The figures are from survey data collected by the National Association for Proton Therapy.) Those numbers are troubling, but the financial figures are worse. During the period in question here, 2012 to 2015, the number of proton treatment centers doubled.

That means the number of prostate cancer patients seen per center is dropping – not a good thing when trying to cover a $220-million investment. Market Struggles And the financial woes extend beyond San Diego. A proton therapy center at Indiana University has closed. Another in Georgia is struggling. This is a tough economic lesson that seems lost in Oklahoma City, where there are two proton therapy centers 17 miles apart, making it even more difficult to attract enough patients to survive.

This bleak economic landscape might look a little bit brighter if researchers could say with confidence that proton beam therapy has clear advantages over conventional radiology. If that is the case, then the centers that survive this downturn might one day pay for themselves.

Unfortunately for proton beam therapy’s purveyors and enthusiasts, there is little evidence of its superiority. The most promising area for the use of proton therapy was once in prostate cancer, where radiotherapy often causes rectal complications, said Joel Greenberger, MD, professor and chair of radiation oncology at the University of Pittsburgh School of Medicine.

But the possible utility of proton therapy in prostate cancer is being undermined by two other developments. One is the realization that many cases of prostate cancer are best left alone and watched, without any treatment. “Ninety-five% of men with prostate cancer do not die of prostate cancer,” Greenberger said.

The other is that proton therapy is, in most cases, no more effective than conventional radiation treatments – and it’s far more expensive. Dwight Heron, MD, chairman of radiation oncology at UPMC Shadyside in Pittsburgh, said that for those men who do need radiotherapy, “we can do it just as well” with conventional treatment.

Proton therapy “does play a role, but we don’t have the clinical evidence yet to support the use of protons for the range of cancers we usually treat – and certainly not at the current cost.” There are no randomized studies that prove protons are better than conventional treatment, he said.

Proton therapy costs range from about $30,000 to $120,000. In contrast, a course of treatment with radiosurgery costs about $8,000-$12,000, Heron said. IMRT (intensity-modulated radiation therapy) costs about $15,000. A radiation treatment center with stereotactic capabilities costs about $7 million to build, versus roughly $200 million for a proton therapy center, according to Heron.

Unique Capability One area in which proton therapy might be uniquely valuable is in the treatment of pediatric cancers, Heron said. “Kids are so much more vulnerable, and they have a higher risk of developing other cancers due to the radiation.” Jatinder R.

Palta, PhD, the chair of medical physics at Virginia Commonwealth University and chief physicist for the Department of Veterans Affairs’ national radiation oncology program, is a strong proponent of proton therapy, but only for a small, select group of patients. In a study he conducted for the VA, he said, “Our analysis did not find any class-one evidence for proton therapy for main cancers like prostate, lung, or any other cancers,” he said.

But there were some exceptions. Some patients present in a way that makes proton therapy “unequivocally better than conventional therapy in terms of morbidity and outcomes.” These cases make up 5%-7% of patients, and it’s not the site of their cancer that makes them good candidates for proton therapy – it’s the way the cancer presents.

If you have a patient you have treated, and the cancer has recurred, let’s say, in the skull, you have a lot of normal tissue which has been irradiated before.
Proton therapy can spare a lot of the normal tissue.” This kind of situation could arise at other sites, too, he said.
These take advantage of a particular characteristic of proton therapy.

X-rays deliver a dose of radiation to normal tissue as they exit the body after passing through a tumor. Protons can be managed to hit the tumor and more-or-less stop dead right there – meaning there is little risk of an exit dose. Palta also underscored the value of proton therapy in treating pediatric cancers.

“When you have a young patient with a growing body and you radiate those normal structures, the growth is stunted. They will not grow at the same rate. Radiation retards the growth of the normal tissue,” he said. Keeping $$ at Home But Palta has a far more disturbing explanation for the economic difficulties facing proton therapy centers.

To explain his view, he does a quick bit of arithmetic. “We are treating about 1 million patients with radiotherapy,” he said. “Let’s say 5% of those patients are going to benefit from protons.” That’s 50,000 people. If proton treatment centers each treated 500 patients per year, there should be enough patients to support 100 centers across the country.

That’s 50,000 divided by 500, if you’re keeping score.) Why, then, are so many of them facing such harsh economic realities? One reason is that insurers are not covering most proton therapy.
But the other explanation is the disturbing one: Radiation oncologists don’t want to give away their income-producing patients.

“No provider is willing to give up patients, even though they know the long-term toxicity and morbidity of the patient they are treating with conventional therapy is bound to be higher,” Palta said. Did he really mean that oncologists would knowingly give patients sub-optimal treatment for financial reasons? Absolutely, he said.

And they’re unlikely to be exposed, because “they can always claim that they don’t know.” He said he’s seen it happen. Before moving to Virginia, Palta was at the University of Florida. “We had a proton facility at Jacksonville and a main campus in Gainesville. Our radiation oncologists in Gainesville would not send patients to Jacksonville.

They would make the excuse that ‘there’s no evidence that protons are better. So why put the patients through a 70-mile drive ?'” This was not a question of competing institutions fighting for healthcare dollars. It was a civil war: both the Gainesville and Jacksonville facilities are part of the University of Florida.

Bottom Line With this background, it’s fair to ask: Is proton therapy a wise buy? No, said Greenberger flatly. “Until we have some incontrovertible evidence that protons for certain things are better, no.” Heron agreed. “It could bankrupt the healthcare system even more quickly.” Palta also agreed. He noted that yet another proton center, in Hampton, Va., 80 miles down the road from him, was also having financial problems.

“They don’t have the patients.” Could this change as researchers continue to study proton therapy? “That’s highly unlikely,” Palta said. “The physics is simple. We know which cases will make a difference.” The only solution, he said, is to treat all of those who can benefit from proton therapy – and only those who can benefit.

How do you qualify for proton therapy?

Proton therapy is most beneficial for patients with solid tumors near critical organs or structures that have not spread to other areas of the body. However, if the tumor has spread (metastasized), proton therapy may still be an option. Proton cancer treatment may also benefit patients who cannot tolerate any more X-ray radiation.

Patients whose tumors are near critical organs or structures, such as brain, heart, lungs, GI tract, spine and head and neck Patients who also need chemotherapy Patients whose cancers have recurred Patients who cannot have any more X-ray radiation treatment and have reached their limit for traditional radiation Pediatric patients

The types of tumors treated using proton therapy will continue to expand as research continues and care teams develop proton cancer treatment plans for more types of tumors. Proton therapy is not appropriate for all types of cancers or all patients. Only a healthcare provider can determine the best approach for each unique condition.

What is the success rate of proton therapy?

Safety and Efficacy of Proton Therapy – Many people with locally advanced cancers are treated with a combination of chemotherapy and either traditional or proton radiation. For patients getting chemotherapy and radiation at the same time, finding ways to limit side effects without making the treatment less effective is a high priority, Dr.

Baumann said.
He and his colleagues analyzed data from nearly 1,500 adults with 11 different types of cancer.
All participants had received simultaneous chemotherapy plus radiation at the University of Pennsylvania Health System between 2011 and 2016 and had been followed to track side effects and cancer outcomes, including survival.

Almost 400 had received proton therapy and the rest received traditional radiation. Those who received proton therapy experienced far fewer serious side effects than those who received traditional radiation, the researchers found. Within 90 days of starting treatment, 45 patients (12%) in the proton therapy group and 301 patients (28%) in the traditional radiation group experienced a severe side effect—that is, an effect severe enough to warrant hospitalization.

What are the disadvantages of proton therapy?

Proton Therapy Side Effects – Proton therapy side effects are similar to those of traditional radiation therapy. Side effects can develop gradually after treatment, and may include:

Sore, reddened skin in the area where the proton beam entered the body. It can look and feel like a sunburn. Hair loss in the treatment area Tiredness or low energy

Additional side effects, depending on the area treated, can include headaches and problems with eating and digestion.

How many times can you have proton therapy?

During proton therapy – You typically undergo proton therapy five days a week for several weeks. However, in some situations, you may undergo only one or a few treatments, depending on your condition. The actual proton therapy treatment may take only a few minutes but expect to spend 30 to 45 minutes preparing before each treatment session.

You may also undergo weekly CT scans to see if the dose you receive needs to be recalculated based on changes in weight, or tumor size and shape. To prepare, you’ll be positioned on a table. Cushions and restraints will be used to hold your body still. Then you’ll undergo an imaging test, such as an X-ray or CT scan, to make sure your body is in the same precise position before each treatment.

Your radiation therapy team will then leave the room and go to an area where they can monitor you. They can still see and hear you. Proton therapy is administered with a machine called a gantry that directs the proton beams at precise points on your body.

How many treatments do you need for proton therapy?

Benefits and side effects of proton radiation for prostate cancer – Studies show that proton therapy is successful in treating and managing prostate cancer. As with all prostate cancer treatments, how well proton therapy works depends on a number of factors, such as how advanced the cancer is and the combination of treatments that it may be used with.

The experts at our center focus on the nuances of a patient’s case so that the patient leaves their consultation with a good understanding of the expected outcome,” said Dr. Goel. There are many benefits to proton therapy when treating prostate cancer. Treatments typically last five to ten minutes and are painless.

Patients undergo between 28 to 44 treatments depending on the specifics of their case. And remarkably, most people do not experience side effects. “Only 15 to 20 percent of patients will have a mild side effect that may warrant an over-the-counter or prescription medication to manage,” said Dr.

Where is proton beam therapy available in Europe?

At present, children are referred to the West German Proton Therapy Centre in Essen (WPE), known as ‘the Proton Centre’. We know that travelling overseas for treatment can be a worrying time for families so this leaflet hopes to answer some of the questions you and your family may have about proton beam therapy.

What are alternatives to proton beam therapy?

Both CyberKnife and Proton are forms of radiation, however CyberKnife has many advantages over proton beam radiation as a prostate cancer treatment. CyberKnife is the most advanced treatment available, using image-guided robotics to destroy tumors while preserving the surrounding tissue.

CyberKnife Radiosurgery is a highly focused radiotherapy also known as stereotactatic body radiosurgery (SBRT).
Unlike conventional radiation techniques traditionally used to treat certain types of cancer, the CyberKnife machine delivers a high dose of radiation in a single or small number of treatments.

It is a non-invasive, painless treatment that may be an alternative to open surgery in many cases. The CyberKnife system uses image-guided robotics to precisely destroy tumors and other lesions with multiple beams of high-energy radiation.Using missile-guided radiation technology to target tumors with pinpoint accuracy, CyberKnife delivers radiation directly to the tumor while leaving healthy surrounding tissue untouched.

Because of this missile technology. CyberKnife therapy requires only five treatments. Each treatment fraction is a much higher dose than given with proton therapy. This is called hypofractionated treatments. A growing body of evidence from clinical studies using CyberKnife hypofractionated radiation treatments (high dose in five treatments) shows that CyberKnife provides more effective treatment compared to the proton beam’s conventional lower dose fractionation treatment.

The chart shows the differences between CyberKnife and Proton Therapy treatments. As you can see, CyberKnife is completed in fewer sessions with better accuracy and the CyberKnife is the only technology where there is continuous correction during treatment while the prostate moves and the patient breathes normally.

CyberKnife Radiation Therapy is used to treat low-risk and intermediate-risk localized prostate cancer and is an alternative to surgery or other types of radiation therapy.
CyberKnife is not a knife at all.
It is an innovative radiation therapy technology called Stereotactic Body Radiation Therapy (SBRT).

It is used to destroy tumors and lesions throughout the body with pinpoint accuracy, leaving surrounding healthy tissue virtually unaffected. It is fast becoming the treatment of choice for prostate cancer treatment. There is no cutting, incision, blood, anesthesia, pain and requires no recovery time.

How much is proton therapy in Prague?

The cost of treatment in Czech Republic – The prices in hospitals listed on the Booking Health website are relatively low. With Booking Health, you can undergo treatment in the Czech Republic at an affordable price.

The average cost for proton therapy treatment in the Czech Republic is approximately 50,000 EUR.
Proton therapy for prostate cancer treatment costs 44,648 EUR.
Proton therapy for brain cancer treatment costs 53,899 EUR.
Proton therapy for breast cancer treatment costs 44,526 EUR.
Proton therapy for lung cancer treatment costs 44,462 EUR.
The cost for proton therapy treatment varies, as the prices depend on hospitals, the specifics of the disease, and the complexity of its treatment.

You also need to consider the cost of additional procedures and follow-up care. Therefore, the ultimate cost of treatment in Czech Republic may differ from the initial price. To make sure that the cost of treatment in Czech Republic is suitable for you, contact us by leaving the request on the Booking Health website.

Is proton therapy available in the UK?

Our Proton Beam Therapy department can treat up to 650 NHS patients per year from across the south of the UK when we are at full capacity.

How long is a course of proton therapy?

How long would my proton therapy treatment last? – Proton therapy treatment courses can last a number of weeks depending on the individual patient. It is normal for patients to receive daily treatments over the course of several weeks. Each proton therapy session lasts about 30 minutes, but is different for each patient.

Can proton therapy be used for all cancers?

Cancers we treat with proton therapy – Proton therapy is used at MSK to treat the following cancers:

Head and neck cancer

Pediatric cancers Spine tumors Breast cancer Sarcoma Brain tumors

Prostate cancer

Most commonly, proton beam therapy is used at MSK to treat head and neck cancers, but we are increasingly using it to target and treat cancers of the spine, breast, sarcoma, brain, and prostate.

Is proton therapy covered by Medicare?

Costs and Insurance | LLUH Proton Therapy Treatment Center Offsetting the costs of proton cancer therapy a primary concern for both patients and LLUMC. This is why the Proton Treatment Center accepts insurance plans from 250 providers including Medicare and Medicaid.

While most medical insurers will consider proton treatment on a case-by-case basis, our financial coordinators will provide further assistance in coordinating these sensitive financial matters.
Proton therapy is typically covered by Medicare.
Our financial coordinators can assist you in working with your insurance company to obtain authorization.

The Proton Treatment Center is ready to assist patients to explore potential assistance options. Contact our staff at for financial help today!

How much does proton therapy cost in Germany?

The cost of treatment in Germany – The prices in hospitals listed on the Booking Health website are relatively low. With Booking Health, you can undergo proton beam therapy in Germany at an affordable price. The cost of proton therapy treatment varies, as the prices depend on hospitals, the specifics of the disease, and the complexity of its treatment.

The average cost of proton therapy treatment in Germany is 75,000 EUR, while proton therapy for prostate cancer treatment costs 80,414 EUR, proton therapy for brain cancer treatment costs 80,670 EUR, and proton therapy for lung cancer treatment costs 80,495 EUR.
You also need to consider the cost of additional procedures and follow-up care.

Therefore, the ultimate cost of treatment in Germany may differ from the initial price. To make sure that the cost of proton therapy treatment and the overall cost of treatment in Germany are suitable for you, contact us by leaving the request on the Booking Health website.

How long does proton radiation treatment last?

Proton therapy treatment typically takes about 30 minutes depending on the area of your body receiving treatment. Most of this time is spent making sure that you are in a very specific position to receive your treatment.

How do you qualify for proton therapy?

Is proton therapy covered by Medicare?

While most medical insurers will consider proton treatment on a case-by-case basis, our financial coordinators will provide further assistance in coordinating these sensitive financial matters. Proton therapy is typically covered by Medicare. Our financial coordinators can assist you in working with your insurance company to obtain authorization.

The Proton Treatment Center is ready to assist patients to explore potential assistance options. Contact our staff at for financial help today!

Is proton therapy cost effective?

Proton beam therapy has only an approximate 54% probability of cost effectiveness at 15 years compared with IMRT at a willingness to pay of $50,000/QALY (Fig 3). The probability of cost effectiveness is only 22% for a trial ending at 5 years, but increases to 36% at 10 years and then finally to 54% at 15 years.

Is proton therapy good for all cancers?

Which cancers are treated with proton therapy? – Proton therapy is useful for treating tumors that have not spread and are near important parts of the body. For instance, this may include cancers near the brain and spinal cord. It is also used for treating children because it lessens the chance of harming healthy, growing tissue.

Central nervous system cancers, including chordoma, chondrosarcoma, and malignant meningioma Eye cancer, including uveal melanoma or choroidal melanoma Head and neck cancers, including nasal cavity and paranasal sinus cancer and some nasopharyngeal cancers Lung cancer Liver cancer Prostate cancer Spinal and pelvic sarcomas, which are cancers that occur in the soft-tissue and bone Noncancerous brain tumors