Proton beam RT not exempt from evidence-based medicine

By Robert I. Parker, MD, FAAP | July 1, 2008

In May 2008 (p. 44), ONI reviewed an article by Herman Suit, MD, and colleagues in which they argued that randomized trials of proton beam therapy vs standard radiotherapy are not needed prior to a wider use of proton beam therapy (Radiotherapy and Oncology 86:148-153, 2008). In an ONI reader poll, 81% disagreed with Dr. Suit, as does Dr. Robert Parker, of SUNY Stony Brook, in his letter below.

I absolutely DO NOT find Dr. Suit et al’s argument against the need for comparative studies of proton beam vs photon beam radiation therapy convincing. While proton beam theoretically offers better therapy, this must be validated in clinical trials. I would also make the same argument for other “advances” in radiotherapy such as IMRT (intensity-modulated radiation therapy).

As the economics of healthcare become more stressed and come under greater scrutiny, physicians must work to make sure that any new technology introduced offers an outcome advantage. Despite Dr. Suit’s comment that we wouldn’t be having this discussion if proton beam RT weren’t so expensive, the fact remains that it is, and this expense cannot be ignored.

While we should not make decisions on the cost of a therapy alone, we should understand its cost-effectiveness or “cost-appropriateness” when deciding whether a therapy is appropriate to bring “on line.” An adherence to evidence-based medicine requires that there is evidence of benefit.

Robert I. Parker, MD, FAAP
Professor and Vice Chair of Pediatrics for Academic Affairs Director, Pediatric Hematology/Oncology
Associate Director, Stony Brook University Cancer Center
SUNY at Stony Brook

We welcome further discussion of this issue. Please send your comments to ONI News Editor Shalmali Pal: Shalmali.Pal@cmpmedica.com

TOPIC INDEX

Cancer Types
Breast Breast (HER2+) Breast (Triple-Negative) CML Colorectal Gastrointestinal GIST Genitourinary Gynecologic Head & Neck	Hematology Kidney (Renal Cell) Leukemia Lung Lymphoma Melanoma Multiple Myeloma Ovarian Prostate Sarcoma
Supportive Care	More Topics
Bone Metastases End-of-Life Care Palliative Care	Ethics in Oncology Practice Management Practice & Policy

All Topics

FROM PHYSICIANS PRACTICE

Five Steps to Improving Patient Access
Judy Capko, May 21, 2013
Patient access is getting increased attention through reform initiatives. Here are five steps you can take to make sure patients get appropriate access to care in your office.

Growing HIPAA Threat – Ignore Windows XP at Your Own Peril
Marion K. Jenkins, May 21, 2013
Chances are good that you have some major ticking software time bombs lurking in your medical practice's computer environment, namely Windows XP and Server 2003.

Finding Physician Work-Life Balance in the Small Moments
Jennifer Frank, MD, May 21, 2013
At my practice and at home, things are always busy. There's laundry or homework, or a patient with needs.

Three Areas to Reduce Costs at Your Medical Practice
Greg Mertz, May 19, 2013
By taking a hard look at reducing costs for staffing, overhead, and technology at your medical practice, you may see increased physician compensation.

Dos and Don’ts for Starting a Physician Blog
Michael Woo-Ming, MD, May 18, 2013
Starting a physician blog can provide your medical practice with marketing benefits, but it's important to do it right.

Proton beam RT not exempt from evidence-based medicine

Join the Conversation