And, Medicare regional contractors could become even stingier down the line, declining coverage for other cancer sites if a few years hence, they determine proton therapy isn't as good as the next new thing.
There's always something to worry about with coverage," says Arzt. "CMS is a roller coaster; from year to year one does not know how it's going to turn out."
UCSD's Department of Radiation Oncology chair Arno J. Mundt, MD, did not respond to a request for comment. But a UCSD spokeswoman released a brief statement saying the university "remains dedicated to providing proton therapy as one of the necessary tools a comprehensive cancer center should have in its arsenal." She referred to last year's press release, which explains UCSD is partnering with Proton Health Partners of San Diego to build "one of the strongest proton center treatment teams in the nation."
Proton beam therapy aims radiation beams from a 6 by 9 foot cyclotron to accelerate protons that zap certain tumors. This nuclear-reactor look-alike, with the weight of a loaded 737 jet, has an aggressive precision that some experts say is far more effective than other cancer treatments.
It is said to result in fewer side effects and cause less damage to healthy tissue than other radiation techniques, as well as non-radiation treatment options like surgery in certain patients. And treatment is an outpatient procedure, taking no more than about 20 minutes.
While the technology is not new, experience is limited but three more proton beam centers are under development in Somerset, NJ, Seattle, and Flint, MI. The oldest, which began in 1990 and is the only facility west of Oklahoma City, is just 95 miles north of San Diego at Loma Linda University.
Van Gorder acknowledges that proton beam is a somewhat risky venture. Candidly, he says, there's probably not enough demand for 3,500 patients in a county of only 3.5 million.
Patients may have to be brought in from across the country.
"Are there enough patients in San Diego for two proton beam therapy center sites? No," Van Gorder says. "Are there enough patients for one site? Maybe. It's all about whether or not the patients can come, and from how far." The closest facilities beyond Loma Linda are in Houston at M.D. Anderson, in Oklahoma City at the ProCure Proton Therapy Center and in Chicago at the CDH Proton Center.
A. Brent Eastman, MD, Scripps Chief Medical Officer and president-elect of the American College of Surgeons, acknowledges that comparative effectiveness of proton beam therapy is largely uncharted territory. That's why Scripps, which treats the bulk of the region's cancer patients, wants to use proton beam as a research tool, "one arrow in our quiver," to look at longer term outcomes compared with other cancer treatments.