Access to proton beam therapy: Tumors Treated in the U.S. (2012-2014) Results and implications of the NAPT survey William F. Hartsell, M.D. Medical Director Northwestern Medicine Chicago Proton Center President, Radiation Oncology Consultants
Objectives 1. Recognize the trends in the numbers of patients treated with protons 2. Discuss the implications of the trends reported in the survey data 3. Discuss the trends in the coding of complexity of treatment Disclosures Joint venture for Northwestern Medicine Chicago Proton Center Honoraria from IBA
Proton therapy in the United States 2012-2014 • Background − Incidence of cancer in US − Incidence by disease types − Utilization of radiation therapy in US • Proton therapy − Overall utilization from 2008-2013 • NAPT survey − Methods − Results • Implications of survey results
Cancer Incidence in the United States
Cancer incidence in the US: 2016 estimates
Trends in Incidence Rates for Selected Cancers by Sex, United States, 1975 to 2012
Cancer deaths in the US: 2016 estimates
Trends in death rates from cancer in the US
Fast Facts About Radiation Therapy Nearly two-thirds of all cancer patients will receive radiation therapy during their illness. In 2004, nearly one million patients were treated with radiation therapy. • Sixty percent (574,930) had not previously received radiation therapy • 88 percent of patients treated with radiation therapy received external beam treatments from a linear accelerator. • 81,580 patients received brachytherapy (seed implant) treatments. • 11 percent of patients receiving radiation were treated with more than one type of radiation therapy. Three cancers – breast cancer, prostate cancer and lung cancer – make up more than half (56 percent) of all patients receiving radiation therapy. At least 75 percent of the patients are treated with the intent to cure • 59 percent of lung cancer patients • 50 percent of brain cancer patients Source: ASTRO website https://www.astro.org/News-and-Media/Media-Resources/FAQs/Fast-Facts-About-Radiation-Therapy/Index.aspx
Proton Centers – 2015 Survey Proton Centers - 2016 WA 2013 ME 2001 MT ND OR VT MN NH ID WI MI SD NY MA RI CT WY 2010 PA IA 2012 NJ NE NV 1957 OH MD DE IL UT IN WV 2010 CO CA 2013 2004 VA MO KS KY 1990 2014 NC 2010 TN 2009 AZ OK AR SC NM AL GA MS 2014 TX LA 2014 2006 FL 2006
Total proton patients treated per year Facility 2008 2009 2010 2011 2012 2013 900* 800* 1000* 1000* 884 945 Loma Linda UCSF 113 87 85 106 124 106 MGH 805 755 697 595 988 795 IU 253 258 255 286 257 239 MDAH 473 700* 1000* 700* 509 837 UFPTI 628 859 832 782 811 813 OKC 0 21 279 323 422 319 Upenn 0 0 0 433 667 644 Hampton 0 0 0 200 289 278 NMCPC 0 0 30 337 473 489 NJ 0 0 0 0 137 375 Seattle 0 0 0 0 0 86 Wash U 0 0 0 0 0 1 3172 3480 4178 4762 5561 5927 From PTCOG website
The NAPT Survey
NAPT Survey Tool
NAPT Survey: Aggregated Survey Results Conditions treated CY 2012 CY 2013 CY 2014* Central Nervous System Tumors 598 639 714 Intraocular Melanomas 250 260 276 Pituitary Neoplasms 50 64 71 Base of Skull or Axial Skeleton 179 239 270 Head and Neck 316 387 576 Lung Cancers 437 490 595 Unresectable Retroperitoneal Sarcoma 16 22 16 Pediatric (Solid Tumors (Up to Age 18)) 685 749 940 Gastrointestinal Tract 170 308 427 Urinary Tract 13 13 24 Female Pelvic Organs 24 29 42 Prostate Cancer 2,336 2,094 2,355 Breast Cancer 93 183 319 Other 210 367 459 Subtotal 5,377 5,844 7,084 Survey respondents 11 13 16
Prostate 2012 2336 Prostate 2013 2094 2014 2355 Aggregated Survey Results Prostate 2500 2000 Number of patients 1500 1000 500 0 2012 2013 2014 Year treated
Pediatrics 2012 685 Pediatric (up to age 18) 2013 749 2014 940 Aggregated Survey Results Pediatrics 1000 900 800 Number of patients 700 600 500 400 300 200 100 0 2012 2013 2014 Year treated
CNS Intraocular Skull base 2012 598 250 179 “Traditional” proton sites 2013 639 260 239 2014 714 276 270 Aggregated Survey Results 800 700 600 Number of patients 500 CNS 400 Intraocular Base of skull 300 200 100 0 2012 2013 2014 Year treated
H & N Lung GI 2012 316 437 170 “Up and coming “sites 2013 387 490 308 2014 576 595 427 Aggregated Survey Results 700 600 Number of patients 500 400 300 Head & Neck 200 Lung 100 Gastrointestinal 0 2012 2013 2014 Year treated
Pituitary RP sarcoma Urinary tract Gyne 2012 60 16 13 24 “Uncommonly treated” sites 2013 64 22 13 29 2014 71 16 24 42 Aggregated Survey Results 80 70 Pituitary 60 Number of patients 50 Retroperitoneal sarcoma 40 Urinary tract 30 Gyne 20 10 0 2012 2013 2014 Year treated
Treatment delivery Levels of Complexity for Treatment Delivery CPT 77520 1,078 1,045 1,416 CPT 77522 58,260 48,876 40,620 CPT 77523 62,321 69,552 95,551 CPT 77525 15,369 20,662 28,741 Subtotal 137,028 140,135 166,840 Survey respondents 9 11 14 Hartsell - Proton therapy numbers
Conclusions: NAPT survey data • The number of patients treated with protons is gradually but steadily increasing – approximately 7,000 people were treated with protons in the US in 2014 • The number of patients treated for “traditional” indications for protons – pediatrics, brain, base of skull tumors, and intraocular melanoma – continues to gradually increase • There is a shift to “new” disease sites treated, especially with an increase in breast, lung, head & neck, gastrointestinal tumors • The number of patients with prostate cancer has remained relatively stable − Despite additional new centers − Relative frequency has decreased from 43.4% in 2012 to 33.2% in 2014 • Complexity of treatments in gradually increasing over time • Not listed - retreatment – this may be substantial number of patients Hartsell - Proton therapy
Acknowledgements All centers for contributions to the data • Hampton University Proton Therapy Institute • Indiana University Health Proton Therapy Center NAPT/ MWE • Loma Linda University Medical Center • Jason Caron • Massachusetts General Hospital • Deborah Godes • MD Anderson • Heather Garecht • Northwestern Medicine Chicago Proton Center • Todd Ketch • ProCure – New Jersey • ProCure – Oklahoma City • Provision Center for Proton Therapy • Seattle Proton Center • Scripps • University of California San Francisco • University of Florida Proton Therapy Institute • University of Pennsylvania Health System • Washington/Barnes Jewish • Willis Knighton
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