ASTRO'S New Model Policy Supports Proton Therapy for Pediatrics

The American Society for Radiation Oncology (ASTRO) has issued a new Model Policy for proton beam therapy (PBT) that details which cancer diagnoses meets ASTRO's evidence-based standards and should be covered by private insurers and Medicare.  Developed by leading radiation oncologists and medical physicists, including significant input from expert representatives in proton therapy, this Model Policy supports PBT coverage for appropriate patients and identifies areas where coverage with evidence development and further research are needed.  

PBT's reduced radiation dose to healthy tissues is attractive because it can reduce side effects for patients, which potentially increases their quality of life. To date, scientific evidence exists confirming that PBT is particularly useful in a number of pediatric cancers, particularly those in the brain, as well as for certain adult cancers such as ocular melanoma.

In identifying and describing appropriate use of proton-beam therapy, the policy lists four circumstances when use of the technology is reasonable (and most pediatric cases would then qualify):

1.      Target volume is close to a critical structure, requiring a steep dose gradient outside the target to limit the structure's exposure.

2.      A decrease in dose inhomogeneity in a large treatment volume is required to avoid an excessive "hotspot" within the target volume.

3.      Use of photon-based therapy carries an increased risk of clinically meaningful normal-tissue toxicity.

4.      The same area or an adjacent area has been previously irradiated, increasing the need for sculpting to limit the cumulative radiation dose.

 

Ama(yo)zing Mayo Clinic Visit

I was honored to be asked to speak at Mayo Clinic last week regarding pediatric proton therapy and the obstacles parents face.  It was hard not to be impressed upon arrival to Rochester as Mayo Clinic and its affiliates seem to occupy most of the downtown.  With some 35,000 employees the town is a hustle and bustle of medical professionals and patients.  The underground Subway system that is not a mechanical subway, but rather a collection of underground walkways, restaurants and shops allows you to go from most downtown hotels to the clinic without ever going outside or needing a car.  When I walked around town, there were numerous restaurants and activities within close distance of the clinic.   I saw people from all over the world and I thought how lucky are we to have great medical care right here in Rochester, Minnesota.   Being a huge Steelers fan, I tried to ignore the town’s obsession with the Vikings – though a good rivalry.

I commend Mayo proton for preparing to treat pediatrics and having the guts to hear from a person like me how hard work it is.  So with the latest in technology, we were able to broadcast my slides and myself all the way to Phoenix and other parts of the center.  My main message included parents (many nontraditional) being high maintenance and the cancer children coming with siblings, grandparents and a lot of other challenges.   I spoke a lot about insurance challenges and what a disaster it is that insurers often hinder a child from receiving proton therapy.  

I then got to tour the new proton center!  There was a lot of excitement because the beam was going live that day.  I loved the design, very bright and crisp, with keeping in mind workflow and efficiency with anesthesia prep and recovery.   All my hosts listened with open ears as I commented from my standpoint.   I just know parents and the kids are loungers and take more space then really necessary (maybe there is something about controlling the corner of a waiting room.)  I wished my best idea wasn’t a new slushie machine, though I can’t imagine anything more fun for a kid coming out of anesthesia or for that matter a grumpy adult.  I had a chance to talk to many different groups that will be caring for the children and all had a focus on how their area could make the experience positive and fun for the kids.  I left that day thinking this is going to be a truly great center keeping with the high expectations one expects from Mayo clinic.  Besides having some of the top pediatric experts in the world – they have people that care enough to ask and listen.  Special thanks to Becky and Shari for making my trip a wonderful and memorable experience!