U.S. Medicare panel to weigh prostate treatments
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)
Well this is it. The first of many of the new policies for the Obummercare where some one in government will be able to decide who gets treatment and for what. The people that will later decide will not care whether your life would be prolonged for even one extra day. It’s all about the money and socialized healthcare like Hitler tried in the 1930’s. It is sickening that our country, America, has come to this!
Health Care coverage is very complex with many stakeholders fighting for their own self- interest. As a prostate cancer patient and health care advocate, my bias is for optimal patient care as determined by patient consultation with their doctors.
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 am also involved in technology and see the benefits that technology can bring to all of us.
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.
As a May 2008 Cyberknife patient of Dr. Sean Collins at Georgetown University Hospital, I can testify to the efficacy of my treatment, having gone in with a Gleason of 3+3 and a PSA of 9.4 rapidly rising. Two years later, my PSA is steady at 0.4, done with painless treatment (except momentarily for biopsy and insertion of fiducials)and NO SIDE EFFECTS. I highly recommend Cyberknife for prostate cancer. I would not want any other treatment for anyone I care about, and some of the alternatives are pretty bad!
I was diagnosed with prostate cancer in August 2008. The advice of my urologist was to select one of many surgery or radiation treatments available. As a 60 year old otherwise healthy person, watchful waiting was not advised.
For the next 6 months I learned about various surgery and radiation treatment options. I chose to receive radiation and chose CyberKnife as the radiation delivery mechanism to minimize risk of collateral damage. I was able to continue working during my 5 treatments and had minimal side effects that quickly cleared. A number of my friends choosing surgery and other radiation delivery methods have missed work, suffered, and experienced substantial side effects.
14 months post treatment my PSA is the lowest in 15 years of annual testing. I hope highly focused, high dosage radiation delivery using a device such as CyberKnife will be made an insurance covered option for all men.
Having been involved with the diagnosis and treatment of prostate cancer for many years as a practicing Urologist, I feel strongly that there is a place for surgery, radiation, hormones, and active surveillance based on the many factors of the disease and the status of the patient in which it exists. Therefore, I was delighted to see the guidelines recently published which helps the physician and the patient arrive at the most appropriate treatment in each individual case. I’m a firm believer that radiation cures prostate cancer and logic dictates that stereotactic radiosurgery is best for several reasons. I have no association with this modality of a financial nature nor am I involved in any arrangement of physician-owned “in-office ancillary” service which I feel has the real potential for self-referral abuse. This is a major part of this entire controversy.
Having said this, I feel that the ideal setting is one in which the Urologist diagnoses prostate cancer in a patient in whom prostate cancer SHOULD be diagnosed, and when ascertaining that this prostate cancer SHOULD be treated, refers the patient to an accredited cancer radiation center at which time, the Radiation Oncologist helps with the decision as to whether or not to go forward. Since the Radiation Oncologist didn’t make the diagnosis, he (or she) is only seeing patients referred by a Urologist who feels that radiation is a viable option in this setting. Now that we are a quarter of a century into the PSA era, most cases diagnosed should be rather early and therefore, it’s reasonable to suggest that perhaps half of them might be candidates for active surveillance. For Urologists to do Radiation therapy is equally incomprehensible as Radiation Oncologists doing surgery. Any careful examination of many of these arrangements will bare this out
As a radiation oncologist, I promise to do my part by not doing surgery.
In an ideal world, all patients would see all the requisite specialists and get their opinions before making a decision as to treatment.
