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Hospitals Look to a Nuclear Tool to Fight Cancer
The feed points us to a NYTimes article about hospitals using particle accelerators to treat cancer. While expensive, proponents say that the proton beams generated by the accelerators are more precise than conventional X-ray radiation therapy. This results in fewer side effects and reduced irradiation of surrounding tissue. The technology's critics say that the cost is not justified by a measurable increase in the level of care given to the patients. Nevertheless, this is an excellent example of "pure scientific research" leading to a useful, unrelated technique. From the NYTimes:
"Tumors in or near the eye, for instance, can be eradicated by protons without destroying vision or irradiating the brain. Protons are also valuable for treating tumors in brains, necks and spines, and tumors in children, who are especially sensitive to the side effects of radiation."
Seems like a good stride forward for medical progress, however I am wondering if there are any potential long term side effects....
Those who live by the sword, get shot by those who live by the gun...
critics is just a shorthand for "Insurance Companies" right?
"Slashdot, where telling the truth is overrated but lying is insightful."
Nope. Next time, go 'nucular'.
Sure, spend precious $$$ on Nuclear Particle things and Proton Beam whosits all developed and pushed by the powerful Atomic Lobby. Won't someone think of the hundreds of poor sharks swimming in evil genius' pools (underneath volcanoes mostly) which have been genetically adapted to have frikken laser beams mounted on their backs solely to help humanity. Yes, yes... there may be some people that "get in the way" like a cerain Mr. Bond, but that's just an unfortunate side effect of the hundreds of dollars in research that I've put into these loving beasts with razor teeth and CO2 lasers.
Signed,
Dr. Evil Dzubin
As another unrelated side benefit, you can strap it to your back and use it to catch ghosts.
Slashdot Burying Stories About Slashdot Media Owned
I doubt they are cancer victims or their families. Would they quibble about the price if it was their health in question? I find it a paradox that the more humans there are, the less humanity you find.
Take the Red Pill.
Correct me if I am wrong (I am not in the US and haven't had any serious illnesses), but isn't medical insurance cover up to a certain limit of dollar value (usually extremely high), which makes the cost of a treatment irrelevant so long as it is scientifically proven to have a noticeable beneficial effect?
If insurance companies refusing a treatment over cost disgusts and shocks you, you might be interested to know that active government policy in every country with free health care (including those highlighted by Michael Moore in 'Sicko') consider on an ongoing basis as a matter of government policy which treatments that WILL NOT be given to people even if they are proven to cure, on the basis of costs, and the list is typically long. And as this case from the UK demonstrates;
http://news.bbc.co.uk/1/hi/england/cornwall/7151328.stm
Does it happen that you have a terminal illness that could be cured by a proven workable drug that is unfortunately not on the government-approved-expenses list? Too bad for you. Do you want to pay for this drug yourself? Well, that sucks, because you are not legally allowed to, in that case you would have to pay for your entire treatment yourself. Of course, you could always travel to a third-world country and have the drug illegally injected, at the risk of losing your house if it's discovered.
It would therefore shock my predictive abilities to the core if any country with a free and universal health care system offered particle accelerator treatments earlier than any country with privately funded health care.
This intended to balance out the general hatred for private medical companies and love for government health care systems with some hard facts and priorities that inevitably are going to be made.
For more information on proton beam therapy, albeit from a provider's point of view, here is a link to Loma Linda's Proton therapy page. (They were the first to set up a proton therapy center.) In addition to static informational and historical pages, there are also some videos explaining what they have to offer and how it works.
although 'modern' medicine offers some benefit, a lot of it is still 'guess your best' & experiment on the rest.
Some benefit? May I remind you that "Life expectancy at birth in the United States in 1900 was 47 years" (http://en.wikipedia.org/wiki/Life_expectancy)?
Compare that to the 77 years we enjoy today... But yeah, the fact that we live on average 30 years longer is just a detail.
I visited a proton accelarator for cancer treatment near Ghent in Belgium 15 years ago. In which way is this new?
10 ?"Hello World" life was simple then
Personally, who cares how expensive it is. I mean, we're not rich people and we are pretty close to that sarcastic "upper lower middle class" line.. but watching my wife go through chemo and surgery (no radiation, thank God) hurt me more than I can ever explain. If there was a way to make sure that radiation was a little "cleaner" and crisp around the edges, I'd say go for it. Chemo and surgery are hell enough.
Plus, x-rays are so last century. Everyone knows the new thing is protons.
Insurance companies frequently follow Medicare's lead, so we may find in a few years that we're paying gobs of money for proton beam treatments that do not offer better outcomes than alternatives. Once it gains acceptance as a standard treatment for cancers on which it offers no better outcome, we'll be paying a huge collective sum in taxes and insurance rates with no discernable benefit.
And yet Medicare is already paying for such treatments? I'm guessing it was all over the major radiation oncology journals?
Yay! Another amazing medical treatment that I can't ever afford.
We're having a particularly slow news day today?
These things have been used all over the world for a very long time now. Over ten years ago I programmed a Proton Therapy Planning System with my brother - and while our system was very fast ( 10 seconds), there were several others around already (usually Suns, 2-4 hours). And the therapy itself was used a lot already - particularly for eye treatment and brain cancers.
Treatment centers were found in Germany, France, England, Japan, South Africa (!) and - yes - even the USA.
So why is this news in any way?
Free PC version of ChipWits at http://www.breueronline.de/klaus/chipwits/
The TRIUMF particle accelerator in Vancouver did work on this in the mid 90's. From what I can remember of their (fantastically interesting) public tour, their work was a significant and marked success. Some information on this can be found here:
http://www.triumf.ca/welcome/proton_thrpy.html
A similar technique was tried in the 1980's:
http://www.triumf.ca/welcome/pion_thrpy.html
that we live longer now primarily due to medicine?
that might have been true 30 years ago, but nowadaze the most 'medicine' sold involves mental health, sex, & the results of obesity, & other unhealthy LIEf'styles'. some of think that 'dying' (a misnomer anyway) would be at least as good as becoming an old fat drug addict.
Ernest Lawrence, inventor of the cyclotron, used accelerators in the treatment of a relative's cancer way back in the day. it would have been protons then, also. they had found out that bombarding aluminum or beryllium produced tons 'o' neutrons, but also knew that particle was to be seriously respected, as it wasn't pulled into anything to crash because of its neutrality.
if this is supposed to be a new economy, how come they still want my old fashioned money?
Therac anyone?
http://www-bd.fnal.gov/ntf/
As i type this, we're shooting protons out of our LINaC at a neutron generatng target (beryllium i think) and treating some person. Many years now.
Dose from photons drops off exponentially and will come out the other side. Electrons deposite too much dose on the surface.
Fast protons go in and stop, leaving their dose mostly where they stop. This depth depends on the energy. You use a spectrum of energies to spread it out where you want it.
Medical Physicist Coward
I hope your wife is doing as well as I am. Cancer is truly a bitch.
Protons are an attractive modality of treatment. They offer attractive depth-dose characteristics (see the previous mention of the Bragg Peak), a higher relative biological effectiveness (they kill more cells per unit dose), and do somewhat better on hypoxic tumors (tumors with areas of low oxygen concentration). And I admit, it sure would be a cool toy to have here at work. But...
There are many practical problems with proton accelerators. First is that they are HUGE; the bending magnet is often 10 to 100 times as large as that of an electron accelerator (used to make x-rays). There are not that many hospitals who have the real estate to accommodate such a machine. Because they are so expensive and expansive, most facilities will only be able to afford one such machine. What do you do when it breaks down? Radiation therapy outcomes can be quite sensitive to skipped days and breaks in the scheduled treatment course, which often are every weekday for 6-8 weeks (which is why we are treating patients on both Saturday and Sunday last weekend and this one, to give our patients Christmas and New Year's Day off without compromising their treatment). As for being "crisper and cleaner around the edges," advanced techniques in photon therapy do this pretty darn well. Intensity Modulated Radiation Therapy can construct dose distributions with very sharp gradients that are comparable to the distributions achieved by protons.
In the end, until superconducting bending magnets become cheap, or until plasma wakefield proton beams achieve the luminosity necessary to be useful in the clinic, protons will remain a niche market. And honestly, for most cases it would make very little difference to me if I or any of my family were treated with x-rays or protons.
Better nutrition and sanitation explains some of that, but yes.
Medical care is a BIG reason we not only live longer - we do so with fewer crippling diabilities.
I don't have a source, but I read somewhere that our disability rate is something like half of what it was before WWII.
Back then we couldn't really hope to reattach a finger, much less still have it retain at least some function.
Safer machinery, again, plays a big roll, but it's there.
I don't read AC A human right
watch how these systems will cost 100M/ unit in America, and in about 3 years, 5 of the same units from the same company will be sold in China for 1 million. It will then be followed by China showing up with a similar idea being sold throughout the world for 200K until the original company is out of business, at which time the price will jump to 1 mill for china, and 100M for the rest of the world.
i declare the death of the rhetoric "particle accelerator? when are they going to cure cancer."
This idea may sound a bit wacky, but I believe that at some point in the future we will have mathematical models of disease, and we will be capable of modelling and "treating" diseases with mathematics. For example, perhaps we could model cancer as some form of deviance from a Pareto optimal frontier of the body or something like that. And when I say "model" I mean to model every cell at very low level (of course we would need good algorithms and supercomputers, but at some point I believe this will be possible). Thus, after having a model of a disease and a model of a human body expressed in mathematical functions, perhaps using some sort of swarm models of the cells of the body, we could then compute the transformations that could lead to health (for example some movement along a Pareto frontier or some tradeoffs between functions representing the efficiencies of various body susbsystems or maybe even groups of cells). Then we could load this mathematical model of treatment onto a swarm of nanomachines and unleash them into the body to heal it by implementing the mathematical treatment. Too wacky, eh?
We spend 15x more on breast cancer treatment and research than on prostate cancer. It pays to be Oprah, where's my ribbon magnet.
Sorry to get all political, but for what we're paying to be in Iraq we could build one of these things every single day. Imagine a country full of cancer-fighting particle accelerators, two or three in every state.
This sig, aah-ah, is comin' like a ghost-sig...
There's nothing new about using a "nuclear tool" in medicine.
http://outcampaign.org/
My dad had prostate cancer and was treated via proton. His PSA's are barely readable (.01). How in the hell can anyone criticize this treatment? Oh, because it cures, and BigPharm doesn't want that.
Now, for me, personally, every single procedure that has a reasonable chance of giving me a normal lifespan (I'm under 30, so figure another 40-60 years) is worth it. I want to live - who doesn't? But reality is that I have an incredibly rare (synovial sarcoma, 800-1000 new cases per year in the US), which is functionally much different than carcinomas (all the big killers, lung/breast/colon, are carcinomas) there isn't much research being done and drugs that are developed for carcinomas don't work for sarcomas. The best drugs they have are decades old. Once my cancer recurred, statistics said I had a 5-8% chance of surviving 10 years.
Now, let's estimate that treating me over the last three years has cost half a million dollars. Was it worth it? For me, my family, my friends, yes, anything the doctors can do is worth it. (I should note that I have insurance, good insurance, because I happen to live in a state with a high-risk pool http://www.mchamn.com/) But was I overtreated, given the probability of a cure? Probably. But it's a lot easier for me to say that now that I don't have any good options left. This article is essentially about the fact that in order to control health care costs, we need to make the decision about how much money to spend on people like me before we treat them. I just read a NYT review of Overtreated http://www.nytimes.com/2007/12/19/business/19leonhardt.html?, which speaks to this very issue. There was one line I particularly liked:
because most Americans think it's the other guy who's getting unnecessary treatment How do you choose who to treat, and who not to treat, and when to stop treatment even though there are more procedures the doctors could do? Yes, proton therapy is better than LinAc-based radiation, but how much, and for whom, and are we willing to pay a lot more for a marginally better outcome? Each of us as individuals will always be willing to pay more, because the added cost is spread over the whole insurance pool. Of course this cost- and risk-spreading is the entire point and benefit of insurance, so we can't throw the baby out with the bathwater. But we need to find a way to decide what is good enough, and how much treatment is enough.
It isn't so much a question of how much we can afford, but how much we are willing to spend, how many other things we are willing to give up as health care spending displaces other spending. Given the urgency of the debate in the US over the rising cost of health care, we are close to or even already past what we prefer to spend on health care. Slowing and stopping the growth in cost ultimately means slowing and stopping the growth (relative to GDP, at least) the growth in care. The politicians won't say it, but that's reality.
How are you going to solve it? Not the NHS way; not the Medicare/Medicaid way. But somehow. And no matter what you choose, someone isn't going to get all the treatment they possibly could, and they might (probably will) be upset. You can see the result of NOT choosing. Time to decide.
See? It pays not to be a dick.
This NYT article has the insiders on edge. Many within our inner circles feel that it is absurd to promote such insanely costly treatment with no proven benefits for cure over the current options which include things such as IMRT (which has advanced care from the 3D methods in certain cases, but has never been proven to improve cure rates).
.02 centigray on the matter. And no, I didn't post this from my real IP obviously.
The reality is - if I could reduce your side effects modestly then great, its worth say IMRT over 3D for head and neck cancer or possibly prostate treatment.
But can anyone in their right minds (other than seeking profit motive) justify proton therapy? Its ability to treat will affect maybe 1% of the treatment population that cannot be treated with other existing methods - and very well, thank you. Gamma knife, Cyber knife, blah blah blah. We have ways of burning money you cannot fathom.
The official position will have to be "here's the data you decide" and the reality will be the marketplace decides.
The ultimate result will be undesirable scrutiny on radiation oncology - a profit center for all hospitals with lucrative high margin reimbursement technology always just on the horizon (carbon ions much?).
The downside is that rad onc physicians (some of whom make over 1M per year, average tho is more like most specialists 500k, but much more than 1M if they own equipment or have extensive practices as independent contractors) will get bundled to death by CMS and sadly this greed by hospitals and equipment owners (some of whom are docs) and manufacturers will hurt rad onc in the long run.
Why don't we work as a nation to covering all those who DO NOT have insurance with the EXCELLENT techonology already have that has proven benefits? Gee.. that wouldn't work well with "profit motive" now would it? And yet what we could save if we tempered the profit motive, and reapplied it to paying hospitals and docs for the uninsured would be simply staggering.
At least, thats my
Not. Maybe they should just bring back the http://courses.cs.vt.edu/~cs3604/lib/Therac_25/Therac_1.htmlTherac-25?
Bugs and all? Does anyone else recall that this (happened in 1985, so some of you may not be up on this stuff) was all caused by the operator using unexpected key sequences to input data. Oh, and no hardware interlocks to prevent massive overdoses.
I bet this new-fangled stuff isn't even multi-mode. Nothing is truly new. May we learn from the past...
Of course, the new stuff is so much better, with better hardware and software. Couldn't happen.
And I don't doubt it. But Linacs aren't 'new'. And using them for cancer treatment isn't 'new' either.
deleting the extra space after periods so i can stay relevant, yeah.
This whole suggestion that Medical treatment with particle accelerators is new is not true. The use of such machines is stock medical stuff and has been so for more than 20 years. As to side effects, here is what my mother was told just after she drank some I-131 made in the local accelerator... In response to her question about cancer risk, she was told, "We don't think you will live that long."
The use of focused beams to shoot tumors is also 20 years old or more. The use of the beams to make Gama, X and even Neutron or Positron beams is not new as well. Sorry no news here folks! The Slashdot people got hornswoggled!
Never Politically Correct ~ I prefer the facts If you don't like what I say, get a life, or comment yourself.
Actually, it's not being a dick that is the problem. It's more like being associated with a dick that is the issue...
Not to mention, if you're male, over 90 years old, and still ahve all your equipment, you probably have prostate cancer.
That's the bad news. The good news is that you need not worry about it until you're 110 or so, maybe later.
deleting the extra space after periods so i can stay relevant, yeah.
I'm an electrical engineer who used to work at the proton accelerator at LLUMC. Here are some facts as I recall them. 1. About 70% of the patients are prostate cancer patients. You can cut it out and lose control of things related to your penis, or use protons. 2. People can walk in, get treated, walk out, play golf, all in the same day. Going to the dentist is probably worse. 3. The radiation pattern is shaped to treat the tumor A. Radiation coming out of the accelerator is one particular energy. If this was directed at the patient, it would treat a plane in the patient due to the bragg peak. B. The beam is passed through a spinning mod wheel. This looks like a bicycle wheel with really thick plastic spokes. This creates a range of proton energies which would treat a "slug" of the patient. C. A thick metal "cookie cutter" is made in the shape of the tumor so that the slug of treated tissue is the shape of the tumor. D. A wax mold that is the shape of the distal side of the tumor is made. This forms, by selectively reducing the remaining engergy of the protons, the leading edge of the radiation slug to be the shape of the tumor. 4. General, blast everywhere, radiation may be useful when the tumors have metastasized, otherwise (engineer not a doctor) protons may be better. 5. Insurance covers protons. 6. Doctors who say, "Protons are just another form of radiation, you don't want that.", are uninformed. They probably don't know the difference between #3 and #4. Go to LLUMC and get an informed opinion. 7. If I get cancer, Protons therapy will be on my list of possible treatments. 8. This type of therapy is ~20 years old. SAIC designed the particle accelerator portion of LLUMC a long time ago. Unless you haven't heard of this before, this is not news. 9. Protons can treat brain tumors that may not be accessible to surgery. (I'm foggy on the details of this. Did I mention that I'm an EE not at Dr?)
When I was at Loma Linda (Calif.) medical center about 5 1/2 years ago when my son was there for a heart transplant, I saw that they had a proton therapy facility for cancer and I don't think it was brand new even then. I didn't have time to learn about it then, so I don't know how many others existed at that time, but there was at least that one.
...the future crusty old bastards are already drinking the Kool-Aid.
From my understanding the largest contributing factor to life expectancy has little to do with us actually living longer. It has more to do with a MUCH lower death rate amoung infants and children and a higher success rate in deliveries. The "average" life span has increased because we no longer have to factor in a 66% (number pulled from my ass) death rate among infants and toddlers. Being born premature in the 1800s was a sure death sentence...not so much today. We dont really live that much longer than our ancestors...we just have fewer deaths among our children so the AVERAGE increases.
"At first, we thought it was just another snake cult."
Children? Fuck those little shits and let them die. It's natural selection in action, and I don't see why adults should pay the price for them; a child is worth less than an adult, anyway, since it's not a real person yet.
While protons at low energy get assorbed really fast, at higher energies they have enough speed to "ignore" the electron clouds they are passing through. Actually they "see" a very low cross-section for electron-proton interaction, so the probablity of them hitting something and depositing energy is low. They deposit energy at a roughly constant rate until they hit a critical velocity at which point the cross-section of the electron cloud goes way up (they are slow enough to "see" the electrons) and they interact much more frequently depositing almost all of their energy in a very narrow window. This is called the Bragg Peak http://en.wikipedia.org/wiki/Bragg_peak . Proton therapy still relies on the electrons that get ripped off of atoms to do the damage as mentioned in my previous post.
There is still some technical challenges with proton therapy though, first: the accelerators/energies you need need larger space than current X-ray based accelerators (and most US cancer centres are small, privately run 1-2 X-ray centres), more shielding (accelerating charged particles admit radiation) over the whole length of the accelerator. Add to this, in order to paint the target with the dose you want you need to either/or/both tune the energy, or adjust the target (by progressively adding more material in front of the patient, etc. filling a bucket of water or something during the treatment to change the effective depth). These aren't impossible to overcome, just would make the treatments more complicated and time consumming than current treatments (but also potentially of better quality) and more expensive.
Another plug: more expensive, more time consumming is the norm in the field. The CT like functionality I mentioned in my earlier post, as well as the simulation methods being utilized (moving more to a tell the system what you want and it optimizes it for you, rather than guessing your self and then doing a dose calculation) are requiring more CPU horse power and more storage. Eg. at my centre we've seen the average patients record, go from mostly the initial CT + plan (~100MB) to closer to 400MB(loads of data generated during the optimization process + a couple more "CTs" after the treatment starts to verify tumor response/position. We treat about 2000 patients a year so just patient data is growing at about 1TB a year this isn't counting research, etc. Everything gets bigger, faster, higher resolution etc on a nearly yearly basis, requiring more network, SAN, server horsepower etc. All equals: job security.
The cancer of my cancer is my friend.
Take life easy: one bit at a time.
The FDA approved proton therapy in 1988. Loma Linda University has been performing the procedure since 1990. Medicare and most insurance companies have approved billing for over a decade.
not new, not controversial, not experimental, NOT NEWS!
It's arguably due to the relatively lower social and economic impact of prostate cancer versus breast cancer. Prostate cancer is uncommon in men less than 45, but becomes more common as men age. The average age at the time of diagnosis is 70. However, many men never know they have prostate cancer. Autopsy studies of men who died of other causes have found prostate cancer in thirty percent of men in their 50s, and in eighty percent of men in their 70s. There are about 30,000 deaths a year from prostate cancer, with the vast majority of those being in the elderly.
The biggest risk factor for prostate cancer is age. Which is to say that since we're living longer we're seeing a lot more of it. Many times prostate cancer is left untreated because the patient is so elderly and the cancer is growing so slowly that they are likely to die of something else first.
Contrast that with breast cancer. Breast cancer is much more aggressive and it is likely to occur at a much younger age than prostate cancer. Breast cancer's impact on women in the prime child rearing and wage earning years is much larger than prostate cancer is on men. The following statistics from the American Cancer Society illustrate this very well.
Breast cancer incidence by age.
Prostate cancer incidence by age.
About 40,000 people (men and women) die from breast cancer a year in the US. About 30,000 men a year die from prostate cancer. Considering the greater social and economic impact of breast cancer, a 1.8 to 1 difference in federal research funding doesn't seem entirely lopsided.
As to money spent on treatment, I think society is just willing to spend more money on helping younger people survive and be productive than it is to help an old geezer make it another five years. If the purpose of medical research and care is to extend lives, it seems reasonable to spend significantly more on breast cancer than prostate cancer.
For most of the world's population the impact of breast cancer versus prostate cancer is much greater due to lower life expectancies. Men rarely live long to be affected by prostate cancer, but women are dying in their prime from breast cancer.
I don't think it's an issue of the US federal government investing too much in breast cancer research and not enough in prostate cancer research, but that not enough is being invested in either one.
Schizophrenia, much?
Not just research - which at this point is almost wasted since morbidity and mortality from Breast CA leveled out more than decade ago - no the total outlay for screening, treatment, surgery, support etc etc etc etc etg. Even the DoD spends between 1 and 2 billion dollars a year in support of breast cancer.
I remember seeing an AIP article wiz by a few months about making proton therapy more economical.. Found it.
http://www.aip.org/pnu/2007/split/833-2.html
- Between 1975 and 1990, the death rate for all races combined increased by 0.4% annually;
- Between 1990 and 2002, the death rate decreased by 2.3% annually.
Unless there was a huge drop in mortality from '90 to '97, and then nothing between '97 and '07, it seems unlikely that mortality rates would have leveled off more than a decade ago. In any case, I think it's reasonable to spend $20 billion annually on research and treatment for a disease that kills, disfigures, and sickens 1 in 24 women by the time they reach age 60 and that kills over 40,000 of them annually.How much of the 1 to 2 billion for the DoD is for the treatment of active duty service members and their spouses? This would constitute a lot of women who have the potential for breast cancer that the military is on the hook to pay for. Young men tend to not come down with prostate cancer, so the DOD would not be spending nearly as much to treat them. It would seem reasonable that the DoD should be spending significantly more on breast cancer. Do you have a reference for the 1 to 2 billion dollar figure that breaks down where the money is going? How much for research, treatment, counseling, cosmetic surgery, prosthetics, etc?
You mean help out the people who gave the capital to make something happen in the first place? The problem isn't profit, it's the profit + massive regulation + massive litigation risk. The reason the govt should handle health care is because the latter two items can't be dealt with adequately in the private sector
Government caused the problems, so it should take over private industry to solve those problems? You're being sarcastic, right?
The trouble with socialized healthcare, is that Freedom is forfeit in the name of cost savings. Those ends don't justify those means.
My God, it's Full of Source!
OUTSIDE_IP=$(dig +short my.ip @outsideip.net)
The person paying for it. In the US that would probably be an insurance carrier (those who pay a higher premium might get access to it). In most of the rest of the world it would be your government (if you are lucky you might get access to it).
Well, there's your problem. I admit it's true - in the US the news has been abuzz with a girl who died because an insurance company refused to pay for a liver transplant until it was too late to do any good (and only through some news media pressure). What I can't understand is how her parents' can live with that excuse. If it were my daughter, I'd sell my house, move into a FEMA trailer, and get into as much debt as possible to pay for that liver transplant myself. I truly can't understand what happened.
The same would go for this linear accelerator treatment. $100K and it's going to save the life of my loved one? Where do I sign?
My God, it's Full of Source!
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