By Daniel E. Smith
July 7, 2021 at 5:00 am ET
In a March tour of the James Comprehensive Cancer Center at Ohio State University, President Joe Biden’s enthusiasm about cancer research and a treatment called proton therapy was unequivocal. Now his administration is weeks away from enacting a controversial Trump-era rule change that could make this cutting-edge cancer treatment inaccessible for many.
Unlike conventional X-ray radiation, proton therapy has the unique ability to precisely target cancerous cells with minimal damage to healthy tissues. Patients treated with traditional radiation often face long-term side effects, and the risk of secondary cancers later in life. Proton therapy minimizes these risks. During his tour, Biden enthusiastically described the innovation taking place there as “a source of hope,” and encouraged a continued “focus on proton therapy.”
Yet the administration may be about to take a step that would drastically limit patient’s access to the amazing benefits of proton therapy. At any moment, the Centers for Medicare & Medicaid Services could implement a devastating policy shift that would effectively deny Medicare patients access to this treatment option.
CMS’s move to change the policy, known as the proposed Radiation Oncology Alternative Payment Model (RO-APM), began under the Trump administration. With the rulemaking process nearing completion, Biden must step in by removing this innovative treatment from the proposed model.
If CMS’ new policy is implemented as written, many cancer institutions would be in the difficult position of not being able to offer their patients proton therapy, as the reimbursement rate would not adequately cover the costs for delivering this sophisticated technology. Many proton centers may be forced to make the difficult decision to close their doors.
With only 38 cancer centers currently providing the treatment in the United States, access for patients will become even more limited. This will lead to an even wider gap in disparities for cancer patients seeking advanced and specialized treatment. For those unable to afford the treatment they’ll be forced to pursue other options–many that lead to unnecessary and permanent side effects–or resort to paying out-of-pocket, a luxury that low and moderate-income Americans are not afforded.
Almost every day, my organization works with patients like Randy Speed who are seeking access to this groundbreaking cancer treatment. Randy is an American Airlines pilot who once was told that his stage-four esophageal cancer was terminal. For many in Randy’s situation, traditional radiation often means lifelong side effects, potentially impacting an individual’s ability to swallow or even requiring the use of a feeding tube. But thanks to proton therapy, Randy is now cancer-free and is likely one of the only commercial pilots still flying after such a devastating diagnosis.
If the RO-APM doesn’t exclude proton therapy, Medicare beneficiaries seeking the same life-saving treatment as Randy may be out of luck.
Biden has long been a champion for patients in the fight against cancer. As we all know and understand, for him cancer is deeply personal. His administration is well-positioned to reverse the mistakes of his predecessor and protect proton therapy access by removing it from this harmful payment model. Cancer patients deserve the right to work directly with their medical teams to determine the best care plan for them.
Biden has committed to making cancer a priority in his administration, and to end this disease as we know it. One critical step on the path to ending cancer is ensuring that cutting-edge cancer treatments like proton therapy are available to all who need them.
Daniel E. Smith is the executive director of the Alliance for Proton Therapy Access.
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