Daily Oklahoman (Oklahoma City)
April 22--Nadine Bye isn't shy about her age.
She's 70, and she will tell anyone who asks because, frankly, she has worked hard to get this far.
Bye has survived two brain surgeries and a bout with breast cancer 10 years ago.
On Tuesday, she had her last proton therapy treatment after being diagnosed for a second time with breast cancer.
Like many people, Bye didn't know about proton therapy until her doctor proposed it.
"Ask me about it, and there's nothing better," Bye said. "I'll swear by it, as far as I'm concerned."
Of the estimated 1.5 million Americans who were diagnosed with cancer in 2009, 60 to 75 percent received radiation therapy for their disease, according to the National Cancer Institute.
For some patients like Bye, they were able to choose proton therapy over other traditional cancer treatments. That's because the ProCure Proton Therapy Center in Oklahoma City recently added breast cancer to the types of cancer it will treat with proton therapy.
But using proton therapy to treat breast cancer is not an agreed upon approach, and many doctors continue to debate what benefit the treatment provides patients.
Bye thought she was done with breast cancer. She was fought cancer at 60, and after 10 years of no news about her cancer, she thought she was in the clear.
But in October, she felt a lump near her collarbone. A doctor's appointment and several tests later, she found out that she had cancer again in her lymph nodes on her right side.
Bye's cancer was too complex to operate on, and doctors decided proton therapy was the appropriate approach.
"The main reason that I wanted to go through proton therapy was it saves other organs," she said. "And when you're having treatment from your neck to your waist, you've got your lungs and your esophagus and your thyroid and all of those organs that could be affected, and with protons, (it) doesn't do that."
Not everyone with breast cancer is a candidate for proton therapy.
Dr. Marcio Fagundes, a radiation oncologist at ProCure, said proton therapy is not meant as a replacement for cancer treatment for all patients.
Rather, ProCure has specific patients it will consider for proton therapy, including breast cancer patients with stage three breast cancer who have relatively large tumors in their breast, chest wall and lymph nodes.
Traditional radiation therapy has been used to treat cancers for a century using radioactive energy rays called "photons," according to the American Cancer Society. Meanwhile, proton therapy is a type of radiation treatment that delivers radiation to tumors using tiny, subatomic particles, or protons, instead of photons, according to the organization.
With breast cancer, one of the main concerns is radiating the breast or chest wall might cause doctors to radiate the person's heart or lungs as well. This sometimes can cause heart disease and complications later in life.
Fagundes said with protons, this isn't the case. With traditional radiation, doctors cannot control how deep the radiation penetrates. But with protons, doctors can determine down to the millimeter where protons should stop, he said.
"Everybody agrees that protons have a tremendous advantage as far as sparing potentially critical tissues like the brain and the spinal cord, and we believe that similarly we can use protons to spare the heart," he said.
However, not everybody agrees on how beneficial proton therapy is or which patients should receive the treatment.
Dr. Bruce Haffty, the president-elect of American Society for Radiation Oncology, said more research is needed to determine what patients would benefit most from proton therapy.
At this point, for a majority of breast cancer patients, proton therapy has yet to prove itself better, he said.
Haffty said if he had a patient who might experience a higher dose of radiation to the heart and lungs than what he thought was healthy, he would consider proton therapy.
"But I think one of the problems is, if we just do it because we think, 'Well, this might be a little bit better,' without doing a fair comparison, we end up just using a technology because it's available, not because it's better," he said.
Haffty said even though proton therapy among adults is debated, the benefit of treating children with cancer is clearer. Children have organs and bones that are still growing, and the theory that radiation could cause long-term side effects is less of an argument.
"For a breast-cancer patient who is fully grown, one where ... it's not a deep-seated tumor, but where you can get good dose distribution with current technology, demonstrating that protons -- which are going to cost perhaps three times as much or more to deliver the same radiation -- even if the dose distribution looks a hair better, is it really worth doing?"
Proton therapy is generally more expensive than other cancer treatments.
Haffty said 30 proton therapy treatments can range upward of $60,000 for treating any type of cancer.
Meanwhile, the average cost of intensity-modulated radiation therapy for breast cancer was $19,388, compared to $4,104 for 3-D conformal radiotherapy, or almost five times more expensive, according to the Center for Healthcare Research and Transformation.
Bye's insurance covered her treatment, and she said she wasn't left with a large financial burden.
But this is not always the case for patients.
David Raubach, the finance manager at ProCure, said the company is currently working with insurance companies to determine coverage.
He said he wasn't aware of anyone who had come in for proton therapy for breast cancer who did not have insurance.
ProCure works with patients to ensure cost isn't a barrier, and the company has financial assistance patients can apply for. Also the company has local charities to cover the cost of treatment.
"Basically, we do everything we can that, if a patient doesn't have insurance coverage, we're going to do everything we can to make sure that patient can still get treated and not have price be a burden," he said.
For now, each patient's case must be individually approved by their insurance company. Raubach declined to release information about how much private insurers pay for proton therapy, saying it was confidential information between ProCure and the insurance company.
"Our plan for breast cancer coverage is to be competitively priced with other treatment modalities, whether that's MammoSite or IMRT," he said. "Our goal and what we have presented to insurance companies is we will be competitively priced with those modalities."
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