Justin Bekelman, Philadelphia Inquirer, Proton Therapy

Justin Bekelman, Philadelphia Inquirer, Proton Therapy

In an article in the Philadelphia Inquirer Justin Bekelman warns that if insurers cease to pay for proton beam therapy for prostate cancer, it will not be possible to complete important clinical trials on that application of the technology.

Bekelman, MD, is an Assistant Professor of Radiation Oncology at Penn's Perelman School of Medicine and an LDI Senior Fellow. His Inquirer interview follows his recent commentary on the same issue in the Journal of Clinical Oncology.

Clinical trial
Bekelman is leading what would be the first clinical trial that would randomly assign prostate
Justin Bekelman
Justin Bekelman, MD

cancer patients to receive either proton or conventional radiation therapy and then monitor those patient outcomes for five years.

The two prostate cancer treatments have significantly different costs. Medicare, for instance, pays about $32,000 for proton therapy and $19,000 for conventional radiation.

According to the National Association of Proton Therapy, prostate cancer treatments account for 60% of all business in proton therapy centers.

Still unclear
The Inquirer reported that "More than a decade after prostate cancer became the economic driver behind proton beam therapy in the U.S., it still isn't clear that men treated with the technology do better than those who get less costly radiation treatments."

Bekelman's clinical trial could clarify the comparative efficacy of the two different treatments for prostate cancer.

However, efforts to recruit patients for the clinical trial and have their treatment costs covered by insurance comes as four major health insurers -- UnitedHealthCare, Aetna, Cigna and Blue Shield of California -- announce they will no longer cover proton therapy for prostate cancer.

The Inquirer reported there are currently 14 proton beam therapy centers in operation across the country and 11 more are being developed at the cost of about $200 million per facility. Meanwhile, just weeks ago, Indiana University shut down its proton therapy center because it had become unprofitable.

Penn Medicine compromise
Bekelman told the Inquirer he advocates wide adoption of a compromise that Penn Medicine has struck with Aetna, Independence Blue Cross, and Horizon Healthcare Services to get coverage for men in the clinical trial.

The University of Pennsylvania's Health System is unusual in that it bills for proton therapy at the same rate as the latest conventional radiation treatment.