Eric Rosenthal Reports

Thoughts and observations about issues, trends, and controversies in the cancer community.

Thursday, May 10, 2012

Is Proton Beam Radiation Therapy for Prostate Cancer Being Used as a Bait-and-Switch Tactic?


There seems to be an arms war being waged in the Philadelphia-area for my future business as a potential prostate cancer patient.


Now I don’t actually have prostate cancer but I seem to fit into the demographic profile that makes me a suitable target for marketing efforts direct and otherwise that are aimed at using new technological toys for treating prostate cancer.


I recently received two direct-mail solicitations within a week from area hospitals urging me to consider their high-tech gadgets for treating prostate cancer.  This has been in addition to some commercials I’ve also heard broadcast about other hospitals’ prostate cancer treatments.


Lankenau Medical Center, a suburban teaching hospital, was promoting its new TruBeam STx linear accelerator that “targets tumors with unparalleled precision, speed, and maximum cancer-killing radiation.” 


The ad also said that prostate cancer could be treated in just five visits versus the standard 40, and the linear accelerator was the “most advanced technology of its kind” in the region.


Interestingly, I happened to have my annual prostate checkup with my Lankenau-based urologist about the same time and was told about the adverse effects of the TruBeam, which, he added, was siphoning patients away from his practice’s own radiation therapy business, a subject I addressed in an OT article in 2006.


The second ad was from Penn Medicine announcing that its Roberts Proton Therapy Center had “more options to treat prostate cancer.”


“If diagnosed with prostate cancer, you have access to the most comprehensive proton therapy center in the world—right here in Philadelphia,” it claimed, touting its benefits including that “the result is a better chance for curing prostate cancer with fewer harmful side effects.”


This message puzzled me because two years ago my colleague Dan Keller and I wrote a five-part series for OT on the uses and misuses of proton-beam radiation therapy (PBRT) for prostate cancer, which lacked sufficient data to warrant its use over other much less expensive radiation therapies.


I had interviewed Stephen M. Hahn, MD, Professor and Chair of Radiation Oncology at the University of Pennsylvania’s Abramson Cancer Center at the time, and he had said that Penn would place  prostate cancer patients only on protocols and that the center was about to embark on a randomized clinical trial with Massachusetts General Hospital comparing PBRT with IMRT.


I called Hahn again this week and told him about his institution’s direct marketing effort to bring me to his facility if I happened to be diagnosed with prostate cancer.


I asked if Penn’s policy for putting prostate cancer patients on protocols had been expanded to include a larger population.


Hahn said that Penn’s institutional review board was just about to review the clinical trial with Mass General, where it had already been approved, and that since our last conversation Penn has had a number of registry studies under way, prospectively collecting data on prostate cancer patients with various risk factors.


“Registry studies are very helpful in assessing how changes in technology have affected therapy,” he said.


When asked about Penn Medicine’s marketing efforts, he said he didn’t know about the specific card I had received but noted that about half of Penn’s prostate cancer patients are self-referred and that this was one way of making them aware of the array of therapies available at an NCI-designated comprehensive cancer center.


I pointed out that using PBRT as a lure and then offering alternative therapies might just be considered bait and switch, which of course, was still better than subjecting patients to expensive treatments that were not proven to be more effective.


I also noted the disclaimer at the bottom of the card that read: “Patients are assessed for proton therapy by a board-certified radiation oncologist, but may be treated with other therapies based on the circumstances of their disease.”


Hahn responded: “I always say to patients when they first come in, and especially if they ask for PBRT [or some other specific therapy] that it is our obligation to discuss all treatment options.  I take a somewhat practical view of this, and my feeling is if you have a disease that is potentially life threatening. you should go see the best doctors at the best facility that you can where you will be offered all of the best treatment options and not just one. 


“And if it’s a way to get people through the door to see our great doctors I actually don’t have a problem with that.  But I do expect doctors to be honest about it, and this is not selling used cars. It would be unconscionable for a doctor to give technology that wasn’t right for a patient even if some marketing thing promised it,” he said.