Prostate cancer

20 April 2010

U.S. Medicare panel to weigh prostate treatments

At a time of growing debate over prostate cancer treatments, U.S. Medicare officials will take a closer look at radiation therapy and its ability to reduce deaths and side effects in men.

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WASHINGTON (Reuters) - At a time of growing debate over prostate cancer treatments, U.S. Medicare officials will take a closer look at radiation therapy and its ability to reduce deaths and side effects in men.The Center for Medicare and Medicaid Services (CMS) has asked a panel of outside experts meeting on Wednesday to say how confident they are that various types of radiation treatment can improve patient outcomes.Researchers have found that many prostate cancers are so slow-growing that most men will die from other causes, sparking debate over whether diagnosis is too frequent and whether treatments, which also include surgery, are excessive.While the meeting will not directly address the agency's reimbursement rates, CMS is seeking advice that could later be used to determine its payment policies. It oversees 45 million elderly and disabled covered by the Medicare health insurance program, about 40 percent of them men.Any changes in how the agency - the nation's largest healthcare payer - covers radiation treatments could affect the use of therapies by companies such as Accuray Inc, Siemens AG, TomoTherapy, and Varian Medical Systems.The experts will discuss the effectiveness of Accuray's CyberKnife robotic radiosurgery system and other radiation treatments such as external beam radiation and implantable radiation "seeds."Much debate surrounds how to treat prostate cancer in the medical community, with surgeons, cancer radiologists and urologists taking different approaches."The problem is trying to find ... the prostate cancers that need to be treated and which ones don't, and that's not perfectly clear today," Dr. Theodore DeWeese, a radiation oncologist at Johns Hopkins Kimmel Cancer Center in Baltimore.CMS has said looking at all the various treatments would be too big a task for one day."The scope of this (meeting) is limited to radiotherapy for the treatment of localized prostate cancer with comparisons to watchful waiting," it said in announcing the panel.CYBERKNIFEMedicare already pays for prostate cancer treatments. But for officials at Accuray, the potential for payment changes is a top concern.With no formal Medicare rule requiring national coverage of its CyberKnife treatment, coverage varies by region. Two areas - the Northwest and parts of the West - have opted against payment.Quentin Helm, Accuray's vice president for patient access, said he hoped CMS would keep the status quo but was concerned a future decision could rule against payment nationwide."When there's doubt about what Medicare's going to do, that can be a deterrent to private insurers" that already offer a "mixed bag" when it comes to reimbursement, Helm said.Prostate cancer affects mostly older men - and Medicare covers those aged 65 and older - but private payers often look to CMS in making their own payment policies.Unlike the use of CyberKnife with other cancers, "with prostate it's kind of spotty," Helm said, referring to private payer coverage.John's Hopkins' DeWeese said there is a lack of consensus about focused radiation products. "As of today, there's very little data to support that approach in terms of its likelihood of a cure," he said. "It might be equally effective, but it's certainly not proven."But Dr. Sean Collins, a radiation oncologist at Georgetown University Hospital in Washington who uses the CyberKnife, said it seems CMS is "trying to hold (CyberKnife) to a higher level of standards."Collins, who will speak on Accuray's behalf on Wednesday but is not a paid consultant, said CyberKnife has the same side effect risks as other types of radiation but requires just a few visits rather than two months of daily doses. "I think CyberKnife is a reasonable treatment option," he said.

 

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