ASTRO calls for coverage of proton therapy treatments

The American Society for Radiation Oncology (ASTRO) has issued a "model policy" for proton beam therapy (PBT), recommending that certain PBT treatments should be covered by Medicare and private insurers.

The move by ASTRO comes at a time when more proton therapy centers are coming online despite questions about the effectiveness of the treatment and as more private insurers are electing not provide coverage.

The policy recommends two coverage groups for PBT: The first is for patients with specific diagnoses for which PBT has been effective, such as pediatric cancers and certain adult cancers like ocular melanoma. The second is for patients with cancer diagnoses. For the latter, evidence of PBT's effectiveness is "still emerging;" to that end, coverage is recommended for patients enrolled in clinical trials or multi-institutional registries to collect data.

The second coverage group would include patients being treated for prostate cancer, which, ASTRO said, is consistent with its previous statement on the use of PBT for prostate cancer, as well as its "Choosing Wisely" list, issued last September. In that statement, and on ASTRO's Choosing Wisely list, the group recommended not using proton beam therapy for prostate cancer unless it is used in the context of a clinical trial.

"Proton beam therapy's demonstrating promise in our continuing efforts to improve survival and cure rates for cancer patients while reducing side effects," Colleen Lawton, M.D., chair of ASTRO's board of directors in an announcement. "As the leading experts in radiation oncology, it is important for ASTRO to provide balanced, evidence-based guidance to payers that ensures access to PBT for cancer patients while being judicious stewards of our nation's and our patients' financial resources."

To learn more:
- check out ASTRO's "Choosing Wisely" list (.pdf)
- see the announcement from ASTRO

Suggested Articles

Children’s National Health System announced a formal partnership with Virginia Tech, including the construction of a biomedical research facility.

Medicare Advantage insurers are eyeing loneliness as a crucial social determinant of health to target.

Welcome to this week's Chutes & Ladders, our roundup of hirings, firings and retirings throughout the industry.