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April 23, 2015
New Coverage Guidelines Put Children & Adults Diagnosed with Cancer at Risk
The Oregon Health Evidence Review Commission (HERC) recently released a proposed state policy position that, if finalized, could put access to life saving treatment at risk for one of Oregon's most vulnerable populations, children on Medicaid diagnosed with cancer.
Washington, April 23, 2015 – PRNewswire-USNewswire --The Oregon HERC coverage guidance on proton beam therapy (PBT) which was recently open for public comment, only supports coverage of malignant ocular tumors, and declines to recommend coverage for pediatric malignant tumors or any other tumors for adult patients. Because this document will be used by public and private payors throughout the state to guide their coverage decisions around PBT, which is an advanced form of radiation, this unprecedented decision has grave implications for residents of the state of Oregon who receive a cancer diagnosis.
The proton beam therapy community, including the National Association for Proton Therapy (NAPT), is alarmed by the HERC guidance which claims to be based on evidence, but fails to take into account hundreds of peer reviewed studies which demonstrate the value of proton therapy and contradicts numerous policies by national provider organizations. The Oregon guidance is inconsistent with many coverage policies from Medicare contractors and private payors. Examples of national policies include the National Comprehensive Cancer Network (NCCN) guidelines, the model policy for proton therapy from the American Society for Radiation Oncology (ASTRO), and the model policy on coverage of proton beam therapy from the National Association for Proton Therapy and endorsed by the Particle Therapy Co-Operative Group – North America (PTCOG-NA). All of these policies support the use of proton therapy for certain patients with conditions not covered in the Oregon guidance.
"In an era where clinical trials utilizing new therapies are yielding unprecedented breakthroughs in the treatment of cancer, the Oregon HERC's draft recommendations on proton therapy, if adopted, would be a significant step backwards in the advancement of cancer care," said Dr. Ramesh Rengan, Associate Professor, Department of Radiation Oncology, University of Washington School of Medicine & Medical Director, SCCA Proton Therapy Center, Seattle. "Oregonians deserve access to care that is proven by scientific evidence to be the best form of treatment for them. These draft recommendations are not only out of step with current standards of care, they would eliminate access to proton therapy for children with cancer who may benefit significantly from this treatment."
"While the entire document seems completely out of sync with the consensus in the scientific community around PBT, the most surprising and disheartening aspect is the lack of coverage for pediatric patients," said Tyler Wilson, Executive Director of NAPT. "This is inconsistent with the current state of evidence and is so very harmful to a population of patients who would most benefit from the reduced amount of radiation delivered in the course of PBT treatment. NAPT is especially concerned about children on Medicaid who may have very limited treatment options," Mr. Wilson added.
Proton beam therapy's chief clinical advantage is that it can precisely localize the radiation, thereby sparing healthy tissue. Conventional radiation causes far more side effects -- including the possibility of secondary tumors -- because it cannot be so precisely targeted. For many patients the precision possible with proton beam therapy is the difference between a cure and treatment failure. Proton beam therapy also can often be used to treat recurrences of cancer when patients can no longer endure additional treatment with conventional radiation.
For pediatric patients with certain head, neck or spinal tumors, PBT offers a unique level of precision that is critical in providing effective treatment and minimizing the risk of secondary damage to healthy tissue. The proven benefits of PBT have made it a critical, growing and effective treatment option available to cancer patients. Approximately 45,000 patients have been treated in the US with proton therapy and more than 100,000 patients have been treated worldwide. US patients are covered by a wide variety of both private and public payors. Coverage is based on significant clinical evidence and multiple national guidelines that support the use of proton therapy for a wide variety of anatomical sites. This acceptance of the evidence supporting the use of PBT by payors and providers across the country was not reflected in Oregon's policy position.
NAPT also is very disappointed to see PBT described as more expensive than other treatment options. That is a mischaracterization of the treatment modality. A growing body of evidence has demonstrated the cost effectiveness of PBT for children and adults when improvements in quality of life, reductions in the risk of a secondary malignancy and fewer long and short term side effects are considered. Oregon's failure to consider these factors provides further proof of the flawed methodology used to draft this document. As of this date, NAPT is unaware that any proton therapy practitioners were consulted by the state.
NAPT has urged Oregon HERC to reconsider and withdraw this document. NAPT offers the expertise of world renowned physicians and scientists who are experts in proton therapy to assist in revising the coverage guidance for PBT. Surely the citizens of Oregon deserve a policy that is developed by experts, that recognizes clinical evidence and sound policy and that offers Oregonians with cancer, including children on Medicaid, the best opportunity for lifesaving treatment.
About the National Association for Proton Therapy (NAPT):
NAPT is a non-profit organization promoting education and public awareness of the clinical benefits of proton beam radiation therapy for cancer treatment. The organization is supported by world-renowned cancer centers that offer life-saving proton therapy treatment to patients. Founded in 1990, NAPT is an advocate for the advancement of proton beam technology and patient access to the unique therapy. Encouraging cooperative research and educating regulators, payment providers, and policymakers about the benefits of the therapy is critical to NAPT's mission. The website (www.proton-therapy.org) is intended to inform patients, health care providers, public and private payers, and the news media about cancer treatment utilizing proton beam radiation.
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