• Who receives proton beam therapy?

    This is an unsurprising truth from Proton Beam Therapy and Treatment for Localized Prostate Cancer: If You Build It, They Will Come, by David S. Aaronson et al.:

    No prostate cancer treatment has been proven superior to the others. There are, however, substantial differences in cost, which are becoming more important to society and are a focus of health care reform in the United States. While there are theoretical advantages to proton beam therapy from a radiation physics standpoint, no study yet has demonstrated its superiority to modern photon-based therapy in terms of either oncologic or quality of life outcomes. To our knowledge, we show for the first time that the availability of a technology, in this instance a proton beam facility, in one’s HRR is associated with a higher likelihood of receiving proton beam therapy compared with those living in an HRR where this technology is not available.

    Proximity matters, even when there’s no proven increase in effectiveness and despite the cost.


    • I’d be willing to bet, that whites and people of higher SES will be more likely to get these newer technologies, when proximate to them, which is an ironic twist of the issue of disparities – sometimes it’s better to have LESS access to the so-called ‘latest and greatest’.

      • That would be tough to demonstrate. The correlation is likely far to high between SES and location to tease out something like this, and furthermore I doubt the underlying phenomena has anything to do with race. Often race ends up being an easy to observe variable to explain discrepencies in care when SES or location is the real culprit.

    • In the absence of evidence that suggests proton beam therapy might be worse, a well-insured or rich person might select proton beam therapy based on the hope that the theoretical advantages will actually be shown to generate improved outcomes. After all, everyone accepts some surrogate measures for health care outcomes; a theoretical advantage is not obviously a bad surrogate measure.

      Moreover, the real advantages of a new technology will only become evident with population based experiences. It doesn’t seem obviously illogical to have the well-insured or rich pay dearly for their hope while they provide evidence about the true value of a new technology.

      • My takeaway, and the reason I posted (though didn’t state because I didn’t feel like getting into it) is that this lend support to the idea that practice patterns in one’s area can be good instruments for treatment mode. Did people choose to live in a location where, one day, proton beam therapy might exist. No, not exactly. I know the counterargument, that there would be unobserved aspects of the population that are correlated with the probability of having nearby access to the latest technology. So, a perfect instrument it is not. But it’s a worthy idea for consideration.

    • Proximity matters, especially when treatment is 5 days a week for a month or two. I don’t have access to the article, but perhaps you should mention how the authors deal with the fact that even if there were an increase in effectiveness to proton-based therapy, people living an an HRR region where this technology is not available would still not be expected to get it.