Hospitals throughout the United States are in a medical arms race, competing for the biggest, newest and "best" technology the health care industry can offer.
And Oklahoma City's health industry is running right alongside the rest of the nation.
By the end of 2013, Oklahoma City will have two cancer centers offering proton therapy, an expensive and somewhat controversial method of treating cancer.
“The unfortunate thing about proton therapy is that it has divided the radiation oncology community into the haves and the have-nots,” said Dr. Sameer Keole, medical director at ProCure Proton Therapy Center in Oklahoma City.
Health care experts agree that the debate around proton therapy points to larger issues of cost that must be solved for the U.S. to have a better and more effective health care system.
Nationwide, there are only about 10 proton therapy centers in operation and another eight centers in development, according to the National Association for Proton Therapy.
Proton beam radiation therapy uses streams of protons, tiny particles with a positive charge, to kill tumor cells, according to the National Cancer Institute.
Proton therapy is thought to be more precise than X-ray radiation, according to the institute.
When a cancer patient is treated with X-rays, the tumor is killed, but so is the healthy tissue around it. Protons are thought to deliver energy that kills a tumor in a more defined path. This theoretically reduces the amount of radiation damage to healthy tissue near the tumor, according to the cancer institute.
Some experts argue that there's not enough evidence to say that proton therapy is any better than conventional cancer therapies in treating common cancers, such as prostate cancer.
More trials sought
The National Cancer Institute has cautioned that, before proton therapy is widely used, more clinical trials are needed to validate where proton therapy is best used.
There are some scenarios, though, where proton therapy has proved better for patients — for example, children with tumors of the eye or at the base of the skull, said Dr. Anthony Zietman, a professor of radiation oncology at Harvard Medical School.
According to research presented this past week at the American Society for Radiation Oncology annual conference, patients undergoing treatment for prostate cancer using proton beam therapy reported a higher quality of life in early follow-up when compared to patients receiving other radiation therapies.
But this wasn't a randomized trial, often referred to as the gold standard in research, and it is being overspun, Zietman said.
What the research suggests is what most research related to proton therapy has suggested — proton therapy likely provides the same, or similar, benefits than other traditional, less expensive forms of radiation, Zietman said.
“No one is saying proton beam is bad treatment — proton beam is good,” Zietman said. “The question is — does it offer value? And this is where Sameer Keole is right — If protons were cheaper, we wouldn't be having this discussion.”
Keole, who has been at ProCure since 2009, talks to groups throughout the U.S. that want to install proton therapy centers.
“I say, ‘Look, if you want to do this for money, I think you're doing it for the wrong reasons. Hopefully it will work out, and it will be at least a break-even proposition, but you have to do it because you believe in proton therapy,'” Keole said.
It's estimated that Medicare reimbursements are between two and three times more for proton therapy. Generally speaking, proton therapy can cost upward of $70,000. More traditional radiation therapy costs about $40,000.