IMRT- for patients or for profit?

[Guest guest]

ASTRO responds to study on growth of IMRT for prostate cancerWed, 11 April 2012

FAIRFAX, VA USA (Press Release) - April 10, 2012 - The American Society for Radiation Oncology (ASTRO) has issued the following statement in response to the study “Growth of high-cost intensity-modulated radiotherapy for prostate cancer raises concerns about overuse” published in the April 2012 issue of Health Affairs:In a recent Health Affairs study, researchers explored the rise in intensity modulated radiotherapy (IMRT) for prostate cancer use from 2001 – 2007. IMRT is quickly becoming a standard treatment for prostate cancer patients. It delivers high doses of radiation to the tumor, providing better cure rates and lower chance of recurrence, and reduces the amount of radiation delivered to surrounding tissues, reducing the risk of side-effects. The authors said “IMRT would represent a major therapeutic advance for men with prostate cancer.” ASTRO agrees, and our position is supported by a study published last month using SEER data from 2000-2009 for prostate patients showing that IMRT improves cancer control, significantly reduces toxicity to the rectum and reduces the risk of hip fractures.We agree with the authors’ call for more data and for more patients to participate in research, such as clinical trials and registries. The Radiation Oncology Institute is currently developing the infrastructure for a registry to collect and analyze data, with the initial pilot project focused on prostate cancer. More than 75 centers have applied to participate in the pilot, which is expected to launch later this year.The authors make a strong point addressing self-referral abuses in the use of IMRT for prostate cancer patients. IMRT reimbursements are higher than traditional radiation therapy because it is more complex and requires significant quality assurance to deliver it safely and effectively. However, because of the necessary high reimbursement rates, urology-owned radiation therapy centers have proliferated across the country. Nearly one in five urology practices now own IMRT machines, according a recent survey in Urology Times. The expansion of these mega-urology practices can dominate prostate cancer diagnosis and treatment services in their market areas and likely played a role in the growth of IMRT use during the study period.The authors cite marketing materials by Urorad Healthcare, a for-profit company based in Mc, Texas, that has “aggressively marketed IMRT to urologists, claiming that treating 1.5 new patients monthly with IMRT could generate more than $425,000 in additional revenue per physician each year.” That certainly sounds like putting profits before patients.In addition to recent The Wall Street Journal, The Washington Post, and The Baltimore Sun reports exposing self-referral abuse in urologists’ use of IMRT, national studies are underway. ASTRO is supporting a town University independent analysis of the effect of physician self-referral on urologists’ use of IMRT for prostate cancer patients. Also, at ASTRO’s request, Congress asked the Government Accountability Office to investigate the clinical and economic impact of physician self-referral on urologists’ IMRT use. We expect these analyses will shine light on how physician self-referral is significantly contributing to overuse of IMRT, similar to the impact on anatomic pathology services revealed in the April issue of Health Affairs.IMRT yields benefits to prostate cancer patients through increased tumor control and fewer side effects, which will ultimately reduce health care spending on prostate cancer and demonstrate the value of IMRT. At the same time, all patients may not be ideal candidates for IMRT and patients should be presented with all of their options, including active surveillance. The problem identified by the authors is not caused by the reimbursement rate of IMRT, which has declined by about 30 percent over the last six years, but rather its overuse on patients who don’t need it.ASTRO respects and appreciates the thorough scholarship of these leading academic researchers in recognizing the clinical advances associated with IMRT and abuses associated with physician self-referral. We will continue to work with Congress to close the self-referral loophole that leads to this abuse and ensure all cancer patients receive the safest, most cost-effective cancer treatments.If you would like to speak to an expert on this subject, contact Beth Bukata or Napoli at 1- or communications@....ASTRO is the largest radiation oncology society in the world, with more than 10,000 members who specialize in treating patients with radiation therapies. As the leading organization in radiation oncology, biology and physics, the Society is dedicated to improving patient care through education, clinical practice, advancement of science and advocacy. For more information on radiation therapy, visit www.rtanswers.org. To learn more about ASTRO, visit www.astro.org.

[Guest guest]

Whenever I see defensive news releases I

look for what might perhaps be unintended comments like:

<snip>..... IMRT improves cancer

control, significantly reduces toxicity to the rectum and reduces the risk of

hip fractures...... <snip>

Hands up all the men who read about an

increase in the risk of hip fractures with standard EBRT, pre-IMRT. I never

heard of that. And weren't we all told that the risk of rectal 'toxicity' was a

thing of the past as far as EBRT pre-IMRT was concerned? Yet IMRT

" significantly reduces " these risks. To do that they must have been

significant to start with surely? Does IMRT " significantly reduce "

the risk of bladder cancer, another risk that has been consistently denied as

being associated with EBRT yet which is being shown as a real risk by longer

term studies?

And how about the statement <snip>

IMRT is quickly becoming a standard treatment for prostate cancer patients.

<snip>?

Anyone got any statistics to show that

surgery has moved away from being the 'gold standard' therapy? Even if IMRT is

a growing choice - maybe foisted on unwary men by urologists with shares in

radiation institutions - I believe it would have a long way to go to become the

'standard treatment'.

All the best

Prostate men need enlightening, not

frightening

Terry Herbert - diagnosed in 1996 and

still going strong

Read A Strange Place for unbiased information at http://www.yananow.org/StrangePlace/index.html

From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of ccnvw@...

Sent: Friday, 13 April 2012 1:54

AM

To: PROSTATE;

ProstateCancerSupport; newdx; ww; seedpods@...

Subject:

IMRT- for patients or for profit?

ASTRO responds to study on growth of IMRT for prostate cancer

Wed, 11 April 2012

FAIRFAX, VA USA (Press Release) - April 10, 2012 - The American Society

for Radiation Oncology (ASTRO) has issued the following statement in response

to the study “Growth of high-cost intensity-modulated radiotherapy for

prostate cancer raises concerns about overuse” published in the April

2012 issue of Health Affairs:

In a recent Health Affairs study, researchers explored the rise in intensity

modulated radiotherapy (IMRT) for prostate cancer use from 2001 – 2007.

IMRT is quickly becoming a standard treatment for prostate cancer patients. It

delivers high doses of radiation to the tumor, providing better cure rates and

lower chance of recurrence, and reduces the amount of radiation delivered to

surrounding tissues, reducing the risk of side-effects. The authors said

“IMRT would represent a major therapeutic advance for men with prostate

cancer.” ASTRO agrees, and our position is supported by a study published

last month using SEER data from 2000-2009 for prostate patients showing that

IMRT improves cancer control, significantly reduces toxicity to the rectum and

reduces the risk of hip fractures.

We agree with the authors’ call for more data and for more patients to

participate in research, such as clinical trials and registries. The Radiation

Oncology Institute is currently developing the infrastructure for a registry to

collect and analyze data, with the initial pilot project focused on prostate

cancer. More than 75 centers have applied to participate in the pilot, which is

expected to launch later this year.

The authors make a strong point addressing self-referral abuses in the use of

IMRT for prostate cancer patients. IMRT reimbursements are higher than

traditional radiation therapy because it is more complex and requires

significant quality assurance to deliver it safely and effectively. However,

because of the necessary high reimbursement rates, urology-owned radiation

therapy centers have proliferated across the country. Nearly one in five

urology practices now own IMRT machines, according a recent survey in Urology

Times. The expansion of these mega-urology practices can dominate prostate

cancer diagnosis and treatment services in their market areas and likely played

a role in the growth of IMRT use during the study period.

The authors cite marketing materials by Urorad Healthcare, a for-profit company

based in Mc, Texas, that has “aggressively marketed

IMRT to urologists, claiming that treating 1.5 new patients monthly with IMRT

could generate more than $425,000 in additional revenue per physician each

year.” That certainly sounds like putting profits before patients.

In addition to recent The Wall Street Journal, The Washington Post, and The

Baltimore Sun reports exposing self-referral abuse in urologists’ use of

IMRT, national studies are underway. ASTRO is supporting a town University

independent analysis of the effect of physician self-referral on

urologists’ use of IMRT for prostate cancer patients. Also, at

ASTRO’s request, Congress asked the Government Accountability Office to

investigate the clinical and economic impact of physician self-referral on

urologists’ IMRT use. We expect these analyses will shine light on how

physician self-referral is significantly contributing to overuse of IMRT,

similar to the impact on anatomic pathology services revealed in the April

issue of Health Affairs.

IMRT yields benefits to prostate cancer patients through increased tumor

control and fewer side effects, which will ultimately reduce health care

spending on prostate cancer and demonstrate the value of IMRT. At the same

time, all patients may not be ideal candidates for IMRT and patients should be

presented with all of their options, including active surveillance. The problem

identified by the authors is not caused by the reimbursement rate of IMRT,

which has declined by about 30 percent over the last six years, but rather its

overuse on patients who don’t need it.

ASTRO respects and appreciates the thorough scholarship of these leading

academic researchers in recognizing the clinical advances associated with IMRT

and abuses associated with physician self-referral. We will continue to work

with Congress to close the self-referral loophole that leads to this abuse and

ensure all cancer patients receive the safest, most cost-effective cancer

treatments.

If you would like to speak to an expert on this subject, contact Beth Bukata or

Napoli at 1- or communications@....

ASTRO is the largest radiation oncology society in the world, with more than

10,000 members who specialize in treating patients with radiation therapies. As

the leading organization in radiation oncology, biology and physics, the Society

is dedicated to improving patient care through education, clinical practice,

advancement of science and advocacy. For more information on radiation therapy,

visit www.rtanswers.org. To learn more

about ASTRO, visit www.astro.org.