By: Lucia Argento
Whenever the word “cancer” arises in conversation, it is normally followed by treatments like chemotherapy and standard radiation. But what a profusion of people do not know about, and what I discovered recently, is another cancer-fighting treatment called proton beam radiation therapy. The reason for its unpopularity amongst cancer patients stems from its modernity and insurance companies harshly criticizing the therapy as experimental. Because of this, insurance companies will not cover the cost of treatment as easily as they do more traditional or popular treatment options.
In 1931, Ernest O. Lawrence founded the Lawrence Berkeley Laboratory which is the radiation facility where “the father of proton beam therapy,” Robert Wilson worked. This lab-produced many Nobel Prize winners and is a top institute for physics researchers. In 1946, Dr. Wilson was the first to propose in his seminal paper the idea that proton beam therapy could be administered to cancer patients. After a series of research, he discovered how the Bragg peak formed by protons could be administered in radiation.
The Bragg peak is an absorbed dose of energy that increases with great depth and low speed as it travels through the body but is said to “peak” when it drops that maximum burst of energy and immediately stops in its place. Regulating the Bragg peak to occur directly on the tumor where the proton beam is also directed, allows the proton energy to deposit precisely on the cancerous area that is trying to be irradiated. The idea behind proton beam therapy is to mitigate the amount of unnecessary radiation to healthy parts of the patient’s body. Patients’ chances of survival are improved by localizing treatment to eradicate cancerous tissue while reducing injury to noncancerous cells. In return, the patient is left with fewer damaging side effects, which is very useful when performing treatment on sensitive areas like the eyes, brain, spinal cord, or on children, where adverse side effects caused by common cancer treatments have a detrimental impact on the patients healing process and overall well-being.
To date, there are now more than two dozen proton beam facilities throughout the United States. The technology in these facilities is comprised of some of the most expensive devices the medical field has ever built. Depending on how many rooms are in a proton therapy center, the price ranges anywhere from 20 million to 225 million dollars.
There is still a lot of unknown when it comes to proton beam therapy because of its newness and the small amount of evidence gathered through trials and studies. In recent court cases, insurance companies like United Healthcare have deemed this type of treatment to be “unproven, investigational, or experimental.” Weissman v United Healthcare Ins. Co. is a prime example of why insurance companies are reluctant to cover the costs of this therapy in cancer patients, even in 2020. Weissman, who was diagnosed with cervical cancer, did not respond to traditional chemotherapy. Harvard specialists working at Massachusetts General Hospital made her a new treatment plan that concluded proton therapy would be the most effective treatment for her condition. After undergoing failed chemotherapy, doctors were worried about damaging healthy bone marrow, so they wanted to minimize potential damage to her next round of treatment. United Healthcare denied her requests for coverage stating that because she had cervical cancer, she did not meet the criteria for coverage of proton therapy and there was no proof that proton therapy would be more effective than standard radiation. United Healthcare recognized that proton therapy irradiates around twice the amount of standard radiation and the company will only pay for this treatment for ocular tumors, arteriovenous malformations, skull-based tumors, and life-threatening conditions under the company’s own discretion. According to the terms of Weissman’s healthcare plan, United Healthcare did not provide coverage for excluded treatments even if recommended by providers or if it was the only available treatment for a person’s condition. That included experimental and investigational services, which the company argued proton therapy was for Weissman’s condition. United Healthcare had board-certified doctors attest that there was not enough evidence to prove that proton therapy would be an effective treatment plan for Weissman’s condition. Weissman appealed, having more doctors vouch for her, explaining she was a good candidate for proton therapy. United Healthcare still denied her on the basis there was not enough clinical evidence that proves proton beam therapy would “change the outcome” to her condition.
However, proton beam radiation therapy has so much potential. The technological advantage of such pinpointed accuracy to save surrounding healthy tissues is what makes the treatment so effective and should be an option covered by insurance for patients asking for it. Popular cancer treatments are usually invasive and hard to recover from. With that being the case, there should be more money put into clinical trials and facilities to make proton beam radiation therapy more easily accessible for cancer patients without having to worry about covering the costs out of pocket. The biggest struggle for patients is getting their insurers to pay for it. It is common in health law to require insurance companies to cover routine costs, but not to pay for investigational services relating to clinical trials. Proponents of proton therapy know the promise of the treatment, and such acceptance by insurance companies will remain unclear until more research is conducted on the treatment. Until then, insurers are scared to cover the costs because they deem certain cancers do not meet specific criteria that allows a patient to qualify for it. Not even the most common forms of cancer treatments are guaranteed to work the way they are supposed to, so why single out proton beam radiation therapy when there is a chance it could save someone’s life?
Student Bio: Lucia Argento is currently a second-year law student at Suffolk University Law School and a Staff Member of the Journal of High Technology Law. She received a Bachelor’s in Criminal Justice with a minor in Legal Studies from the University of Central Florida in 2017.
Disclaimer: The views expressed in this blog are the views of the author alone and do not represent the views of JHTL or Suffolk University Law School.
