Reuters Photojournalism
Our day's top images, in-depth photo essays and offbeat slices of life. See the best of Reuters photography. See more | Photo caption
The SpaceX mission
A privately owned unmanned rocket blasts off on a mission to be the first commercial flight to the International Space Station. Slideshow
U.S. Medicare panel to weigh prostate treatments
WASHINGTON |
WASHINGTON (Reuters) - At a time of growing debate over prostate cancer treatments, U.S. Medicare officials will take a closer look at radiation therapy and its ability to reduce deaths and side effects in men.
The Center for Medicare and Medicaid Services (CMS) has asked a panel of outside experts meeting on Wednesday to say how confident they are that various types of radiation treatment can improve patient outcomes.
Researchers have found that many prostate cancers are so slow-growing that most men will die from other causes, sparking debate over whether diagnosis is too frequent and whether treatments, which also include surgery, are excessive.
While the meeting will not directly address the agency's reimbursement rates, CMS is seeking advice that could later be used to determine its payment policies. It oversees 45 million elderly and disabled covered by the Medicare health insurance program, about 40 percent of them men.
Any changes in how the agency -- the nation's largest healthcare payer -- covers radiation treatments could affect the use of therapies by companies such as Accuray Inc, Siemens AG, TomoTherapy, and Varian Medical Systems.
The experts will discuss the effectiveness of Accuray's CyberKnife robotic radiosurgery system and other radiation treatments such as external beam radiation and implantable radiation "seeds".
The immediate impact on stocks is likely to be neutral, said Josh Jennings, a medical device equities analyst at Jefferies & Co.
But "if they feel that radiation therapy is being overutilized, there could be a chance for some negative recommendation" that could later cause some waves, he said.
Much debate surrounds how to treat prostate cancer in the medical community, with surgeons, cancer radiologists and urologists taking different approaches.
"The problem is trying to find ... the prostate cancers that need to be treated and which ones don't, and that's not perfectly clear today," Dr. Theodore DeWeese, a radiation oncologist at Johns Hopkins Kimmel Cancer Center in Baltimore.
CMS has said looking at all the various treatments would be too big a task for one day.
"The scope of this (meeting) is limited to radiotherapy for the treatment of localized prostate cancer with comparisons to watchful waiting," it said in announcing the panel.
CYBERKNIFE
Medicare already pays for prostate cancer treatments. But for officials at Accuray, the potential for payment changes is a top concern.
With no formal Medicare rule requiring national coverage of its CyberKnife treatment, coverage varies by region. Two areas -- the Northwest and parts of the West -- have opted against payment.
Quentin Helm, Accuray's vice president for patient access, said he hoped CMS would keep the status quo but was concerned a future decision could rule against payment nationwide.
"When there's doubt about what Medicare's going to do, that can be a deterrent to private insurers" that already offer a "mixed bag" when it comes to reimbursement, Helm said.
Prostate cancer affects mostly older men -- and Medicare covers those aged 65 and older -- but private payers often look to CMS in making their own payment policies.
Unlike the use of CyberKnife with other cancers, "with prostate it's kind of spotty," Helm said, referring to private payer coverage.
John's Hopkins' DeWeese said there is a lack of consensus about focused radiation products. "As of today, there's very little data to support that approach in terms of its likelihood of a cure," he said. "It might be equally effective, but it's certainly not proven."
But Dr. Sean Collins, a radiation oncologist at Georgetown University Hospital in Washington who uses the CyberKnife, said it seems CMS is "trying to hold (CyberKnife) to a higher level of standards."
Collins, who will speak on Accuray's behalf on Wednesday but is not a paid consultant, said CyberKnife has the same side effect risks as other types of radiation but requires just a few visits rather than two months of daily doses. "I think CyberKnife is a reasonable treatment option," he said.
(Reporting by Susan Heavey; Editing by Tim Dobbyn and Diane Craft)
- Tweet this
- Link this
- Share this
- Digg this
- Reprints
This specific topic is an example of the struggle for innovation improving health care and reducing cost.
The CyberKnife can deliver radiation to a tumor more precisely than any other treatment. The CyberKnife is the only treatment that automatically tracks movement of the prostate between delivery of beams of radiation. The CyberKnife is an economic threat to; 80-90% of radiation oncologist, > 90% of the radiotherapy treatment centers, and the largest manufacturers of IMRT and Proton Therapy.
As a technology entrepreneur, and prostate cancer patient treated with the CyberKnife, I understand the contribution of technology to health care. But the technology that treated me, at lower cost than other radiation therapy treatments, is being hampered by health care stakeholders (such as ASTRO) who put their financial interests ahead of patients and the cost of care to society.
Those with power have a responsibility to put ethics and patient well being above their economics interest. Sadly some of the ASTRO leadership publicly misrepresent the CyberKnife. This has been brought to the attention of the ASTRO board of Directors, they failed to provide oversight for there leaderships irresponsible public comments.
The question is how can society and government, act to prevent health care stakeholders from mounting obstacles to technologies such as the CyberKnife?
I am attending the CMS (MEDCAC) meeting referenced in this article meeting.
I was diagnosed with Prostate Cancer a year ago and elected to be treated by CyberKnife.
I had a 3 month battle with my insurance company as they considered it investigational even though there have not been signficant trials for either of the other radiation treatments, IMRT or Proton Beam.
This was and still is the best decison I could have made.
CyberKnife in treatment of Prostate Cancer is less expensive, faster and has less side effects.
As a financial executive who has been involved in the purchase of health insurance for my employers, I am appalled that a less expensive treatment is not approved.
As a taxpayer, I am also appalled that Medicare may not approve a less expensive treatment for Prostate Cancer. According to the peer-to-peer medical review in my appeal, CyberKnife has at least the same cure advantage as other radiation treatments.
Follow Reuters