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McLaren, Beaumont on the Beam for Cancer Treatment

Monday, April 20, 2015   (0 Comments)
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From Crain's
By Jay Greene

Seven years after fierce battles over the need for multiple proton beam cancer centers, McLaren Health Care Corp. this spring expects to open the first proton beam therapy center in Michigan, next to its 458-bed McLaren Regional Medical Center in Flint.

McLaren officials told Crain's they hope to conduct their first treatment on a prostate cancer patient in one of the three rooms that are part of the $50 million McLaren Proton Therapy Center.

But Troy-based Beaumont Health, which first proposed a $159 million proton beam center in 2008, isn't far behind. Beaumont plans to open a $40 million, single-room proton beam center in Royal Oak in spring 2017.

Proton beam therapy is a controversial form of megavoltage radiation that some have suggested is effective in some prostate and pediatric cancers because it causes less damage to surrounding tissue while directing high dosages at tumors.

It also has been used to treat lung cancer and cancers of the head and neck, although the lack of peer-reviewed clinical trials has been criticized.

Nationally, 13 proton beam therapy centers are operating, and at least 12 more are in development, according to the National Association for Proton Therapy. Depending on the size of the center, costs range from $30 million to more than $200 million.

'Nothing can beat it'

Hesham Gayar, M.D., chairman of radiation oncology at McLaren's Great Lakes Cancer Institute in Flint and medical director of the proton center, said McLaren plans to conduct clinical and basic science studies to prove the value of proton therapy.

"For pediatric spinal cases, nothing can beat it," said Gayar, who came to McLaren three years ago from M.D. Anderson Cancer Center in Houston.

Gayar said McLaren has a variety of clinical protocols in place for a range of proton-based cancer treatments. Two of the proton center's rooms will be for adults and the third for pediatric cases, he said.

Don Kooy, CEO of the McLaren Flint hospital, said the proton center will enhance the existing cancer center operations, drawing more patients from the state and Midwest. At full capacity, the center will treat 100 patients a day, Kooy said.

"We will have much more volume" overall in the cancer center, he said. "It will expand our numbers, not subtract from them."

Craig Stevens, M.D., Beaumont's chairman of radiation oncology, said McLaren's center will not affect the number of proton treatment patients at Beaumont.

"We have a large system with 11,000 new patients coming into our system each year," Stevens said.

David Wood, M.D., Beaumont's chief medical officer, said adding proton therapy will be a boon for Beaumont patients.

"We believe proton beam therapy is appropriate for select types of cancers, including pediatric," Wood said. "We think it will be a destination center for the state and region and enhance our cancer center."

McLaren's proton beam machinery and Radiance 330 cyclotron were made in Russia and shipped to Michigan three years ago, Kooy said. Construction and approval from the U.S. Food and Drug Administration took several years to complete, he said.

"We can start whenever we want," Kooy said. "We are doing internal quality control testing now to make sure it is all working." 

The first treatment will be for prostate cancer, Kooy said. 

"It is the simplest to do and has the most outcomes research," he said. "We can do prostate in five treatments rather than 30" for intensity modulated radiation therapy, also known as IMRT or photon therapy. 

"It saves patients time, and it is better for patients and important for payers who pay for it," Kooy said.

Insurance coverage mixed

But will health insurers such as Blue Cross Blue Shield of Michigan, Priority Health, Aetna Inc., United Healthcare and Health Alliance Plan pay for the treatment?

Several locally based health insurers say they will cover some proton therapy, including Priority, HAP and Blue Cross.

However, national insurers Aetna and Cigna Corp. have announced they will not cover proton beam therapy for prostate cancer. Cigna will pay for eye cancer only. United Healthcare will cover only skull-based tumors, abnormal connections between arteries and veins in the brain, and some pediatric cancers.

Priority Health officials told Crain's that the insurer covers some proton beam therapy services when traditional radiation treatment is difficult or impossible.

Blue Cross will pay for proton therapy in a limited number of conditions. They include uveal melanoma, a rare cancer of the eye; chordoma, a cancer in the base of the skull, neck and lower back; pediatric tumors; and brain tumors where critical structures may be at risk.

Naim Munir, M.D., HAP's chief medical officer, said the health insurer will cover some proton beam therapy when evidence suggests that proton therapy would be more effective than other choices. That could include certain types of brain and eye tumors and pediatric cases, Munir said.

Over time, Kooy said, other Michigan health insurers are likely to cover proton therapy and expand treatment coverage once they see results.

Proton pros, cons

The advantages and disadvantages of proton versus photon therapy have generated robust scientific debate, said Joe Spallina, a consultant with Ann Arbor-based Arvina Group LLC, which specializes in health care and cancer program strategic planning.

"Proton therapy does have less residual tissue damage than IMRT and a shorter treatment period for prostate patients," Spallina said.

While Medicare pays for prostate cancer proton therapy, Spallina said, proton centers need to generate at least 50 percent of their business from commercial insurance or self-pay to cover their higher overhead costs.

A 2013 study on Medicare patients published in the Journal of the National Cancer Institute found proton therapy cost 70 percent more than photon therapy.

"We will lower the costs because the treatment periods will be much less," said McLaren's Gayar. 

In 2008, the Economic Alliance for Michigan opposed plans for several proposed proton beam centers, primarily because of the high construction costs and a lack of evidence of superior treatment over traditional cancer therapies.

 

Concerns on cost, use

Besides the earlier Beaumont plan, several other hospitals, led by Detroit-based Henry Ford Health System and the Ann Arbor-based University of Michigan Health System, had considered building a proton beam center in a joint venture. They later studied a $300 million carbon ion therapy cancer center before tabling the plans because of the recession in 2009.

Bret Jackson, the alliance's president, said a recent model policy from the American Society for Radiation Oncologists recommends that proton beam therapy is appropriate for certain head and neck tumors in adults and children.

"We are concerned about the amount of money spent purchasing the equipment and facility to house it," Jackson said.

"We are also concerned about the utilization of service where tumors are not appropriate. (Hospitals) may try to push utilization to recoup the financial investment in the facilities on inappropriate cases."

McLaren has a joint venture with ProTom International, a Flower Mound, Texas-based company. Beaumont is developing its project with Proton International, an Atlanta-based proton therapy development group.

When Beaumont completes its two-story building, the 17,000-square-foot proton center will be on the first floor with an 8,000-square-foot second floor that will house the pediatric oncology and hematology program of Beaumont Children's Hospital.

"We will have the capability to treat cancer that would have otherwise been considered unsalvageable and incurable," said Beaumont's Stevens.

He estimates the proton beam center will create at least 30 clinical positions at Beaumont.

Kooy said McLaren will employ 50-60 when all three rooms are operating.

Next to the proton beam center is a 32-room hospitality house, a hotel for patients and their families that opened in July 2013, said Greg Lane, McLaren's chief administrative officer.

The hotel rooms, partially subsidized by the Ann Arbor-based Hope Foundation, are $35 per night or $50 for larger rooms, Lane said.

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