CyberKnife Society Webinar :Interested in a Pancreatic Protocol Concept?
July 12th, 2010
 |
||||||||||||||||||||||||||||||||||||||||
|
|
|
|
||||||||||||||||||||||||||||||||||||||
|
|
||||||||||||||||||||||||||||||||||||||||
CyberKnife Miami Physicians Dr. Garcia and Dr. James G. Schwade visit Dominican Republic radiotherapy center to present medical seminar
May 19th, 2010
MedCAC Summation from James G. Schwade, M.D. Report from Baltimore, MD
May 3rd, 2010As you may already know, CMS held a meeting last Weds, April 21, 2010, in Baltimore, to assess the status of radiation therapy treatments in general, for prostate cancer. Here’s my inpretation and opinion regarding the meeting, gathered from talking to numerous participants, including our own staff members, as well as members of the Cyberknife Coalition Board (of which I’ve been a member for over 6 years and of which I’m Treasurer) and others.
There was much interest in this meeting, which was attended by many representatives of the radiation therapy community. Among those testifying was Chrissie Kotwica RN, our nurse liason, and Dr. Jim Hevezi, Chief of Physics at the CKC Miami was one of the panel members, as he is one of the approximately 98 MedCAC members! It was anticipated that some specific action, possibly negative, would be taken regarding Cyberknife. The common perception in the general medical community, and perpetuated by organized radiation oncology, has been that while there’s good evidence for RT for prostate treatment, the data on CK is not yet mature enough or large enough.
In actuality, the committee reached a much different conclusion. In fact, the major conclusion was that none of the radiation therapy treatments currently being used is supported by sufficient data to clearly indicate effectiveness versus watchful waiting, let alone superiority to other treatments. However, it was also clear that no other modality, surgical, RT, etc., had data sufficient to satisfy the current “evidence based” requirements. In this light, CK was no better or worse than any of the other treatments. The panels recommendation was that at this time there would be no change in coverage, and no National Coverage Determination (”NCD”), with coverage decisions to be left to the local intermediaries.
Significantly then, while we did not get a determination mandating coverage, there is no change in current coverage, nor an NCD. However, Cyberknife/SBRT now seems to be accepted along with other radiation therapy modalities, none of which seem to have much more data than to support their use than Cyberknife/SBRT.
In this landscape, Cyberknife is the only modality to be ready with a registry to track it’s use and efficacy, a significant situation since there is a dirth of randomized clinical trials for any other treatments, and the conduct of randomized trials in prostate cancer is, at the most optimistic, highly impractical, highly unlikely. In my opinion, given the importance of this disease and long experience with various time, dose and fractionation schedules which have been used, there is a real question regarding whether it is even ethical to require of patients and physicians to enter randomized clinical trials for this disease.
I think it’s important to note, that given the likelihood that Cyberknife/SBRT is at least equally as efficacious as other forms of radiation therapy for prostate cancer, it offers the potential for shorter treatment times, less costly treatment in terms of direct cost of treatment and lost patient time, and less toxicity. This possibility of marked improvement in time, cost and toxicity should be emphasized as a strong reason for resources to be committed to clarify the role of Cyberknife and SBRT for prostate cancer. This would include supporting a registry. As you know, there is a Florida registry, in which CKC Miami and CKC PB will be participating, funded by the participating facilities. This is the first of it’s kind, of which I’m aware, certainly with prostate cancer, and likely with most other sites, as well.
So I think the result of this meeting was actually quite favorable for Cyberknife treatment of prostate cancer. It has finally been recognized as on par with other existing modalities, in particular other radiation therapy treatments, and the potential advantages were clarified. We are therefore, eager to continue supporting additional treatment at our sites, and will be contacting our radiation oncologists and urologists to see where we can assist them in caring for their patients with prostate cancer. Please, as ever feel free to contact me should you have any questions regarding treatment for prostate cancer.
James G Schwade MD FACR FACRO FASTRO
Executive Director,
Cyberknife Centers of Miami & Palm Beach
Clinical Prof. of Radiation Oncology &
Former Chairman,
Dept. of Rad. Onc., UM Miller Sch. of Med.
Adjunct Prof. of Biomedical Engineering
Dept. of Biomedical Engineering, FIU
305-812-2722 (c)
305-279-2900 (o)
305-279-1415 (f)
www.morsecyberknife.com
www.cyberknifemiami.com
www.cyberknifepalmbeach.com
www.canceranswers123.com
www.ca123.com
Financial Assistance Programs for Cancer Patients in South Florida
April 26th, 2010If you are a family member is diagnosed with cancer, the first thing you should do is discuss any concerns you may have about costs directly with your doctor, a hospital social worker, or the business office of your hospital or clinic. These people deal with healthcare costs every day and are your best source of advice. Cancer is tough enough without having to worry about financial ruination during treatment, so get the money issues taken care of first. The agencies and private organizations listed below may offer financial assistance programs for cancer patients in Florida.
U.S. Medicare panel to weigh prostate treatments
April 21st, 2010
WASHINGTON (Reuters) – At a time of growing debate over prostate cancer treatments, U.S. Medicare officials will take a closer look at radiation therapy and its ability to reduce deaths and side effects in men. The Center for Medicare and Medicaid Services (CMS) has asked a panel of outside experts meeting on Wednesday to say how confident they are that various types of radiation treatment can improve patient outcomes. Researchers have found that many prostate cancers are so slow-growing that most men will die from other causes, sparking debate over whether diagnosis is too frequent and whether treatments, which also include surgery, are excessive. While the meeting will not directly address the agency’s reimbursement rates, CMS is seeking advice that could later be used to determine its payment policies. It oversees 45 million elderly and disabled covered by the Medicare health insurance program, about 40 percent of them men. Any changes in how the agency — the nation’s largest healthcare payer — covers radiation treatments could affect the use of therapies by companies such as Accuray Inc, Siemens AG, TomoTherapy, and Varian Medical Systems. The experts will discuss the effectiveness of Accuray’s CyberKnife robotic radiosurgery system and other radiation treatments such as external beam radiation and implantable radiation “seeds”. The immediate impact on stocks is likely to be neutral, said Josh Jennings, a medical device equities analyst at Jefferies & Co. But “if they feel that radiation therapy is being overutilized, there could be a chance for some negative recommendation” that could later cause some waves, he said. Much debate surrounds how to treat prostate cancer in the medical community, with surgeons, cancer radiologists and urologists taking different approaches.
“The problem is trying to find … the prostate cancers that need to be treated and which ones don’t, and that’s not perfectly clear today,” Dr. Theodore DeWeese, a radiation oncologist at Johns Hopkins Kimmel Cancer Center in Baltimore. CMS has said looking at all the various treatments would be too big a task for one day. “The scope of this (meeting) is limited to radiotherapy for the treatment of localized prostate cancer with comparisons to watchful waiting,” it said in announcing the panel.
CYBERKNIFE
Medicare already pays for prostate cancer treatments. But for officials at Accuray, the potential for payment changes is a top concern.With no formal Medicare rule requiring national coverage of its CyberKnife treatment, coverage varies by region. Two areas — the Northwest and parts of the West — have opted against payment. Quentin Helm, Accuray’s vice president for patient access, said he hoped CMS would keep the status quo but was concerned a future decision could rule against payment nationwide.
“When there’s doubt about what Medicare’s going to do, that can be a deterrent to private insurers” that already offer a “mixed bag” when it comes to reimbursement, Helm said.Prostate cancer affects mostly older men — and Medicare covers those aged 65 and older — but private payers often look to CMS in making their own payment policies.Unlike the use of CyberKnife with other cancers, “with prostate it’s kind of spotty,” Helm said, referring to private payer coverage. John’s Hopkins’ DeWeese said there is a lack of consensus about focused radiation products. “As of today, there’s very little data to support that approach in terms of its likelihood of a cure,” he said. “It might be equally effective, but it’s certainly not proven.” But Dr. Sean Collins, a radiation oncologist at Georgetown University Hospital in Washington who uses the CyberKnife, said it seems CMS is “trying to hold (CyberKnife) to a higher level of standards.” Collins, who will speak on Accuray’s behalf on Wednesday but is not a paid consultant, said CyberKnife has the same side effect risks as other types of radiation but requires just a few visits rather than two months of daily doses. “I think CyberKnife is a reasonable treatment option,” he said.
Article from Yahoo Daily News, http://news.yahoo.com/s/nm/20100418/hl_nm/us_medicare_prostate_preview
CyberKnife Center of Miami is advising the national MEDCAC on Treating Prostate Cancer with Radiotherapy
April 21st, 2010Chief Medical Physicist James M. Hevezi, PhD, FACR/FAAPM, CyberKnife Center of Miami, is advising the National MEDCAC, (Medicare Evidence Development & Coverage Advisory Committee)on Treating Prostate Cancer with Radiotherapy Modalities today April 21st. Along with 8 other experts on prostate cancer, he will advise on CyberKnife SBRT, External Beam, Brachytherapy, IMRT. He will also present on which modalities should be covered and reimbursed by Medicare insurance. The Medicare Evidence Development & Coverage Advisory Committee (MEDCAC) was established to provide independent guidance and expert advice to CMS on specific clinical topics. The MEDCAC is used to supplement CMS’ internal expertise and to allow an unbiased and current deliberation of “state of the art” technology and science. The MEDCAC reviews and evaluates medical literature, technology assessments, and examines data and information on the effectiveness and appropriateness of medical items and services that are covered under Medicare, or that may be eligible for coverage under Medicare. The MEDCAC judges the strength of the available evidence and makes recommendations to CMS based on that evidence.
News from James G. Schwade, M.D., Executive Director
April 20th, 2010ASTRO ETC report on SBRT for Lung CA
The ASTRO Emerging Technology Committee last week released it’s report on Stereotactic Body Radiotherapy (SBRT, as you know, is the term of art for extracranial radiosurgery) for Lung Cancer. It is exciting to see that they have concluded that SBRT is an acceptable treatment option for non-operable Stage I-II NSCLC! However, they stopped short of accepting it as an option for operable patients, at this time, citing the need for more follow-up. They do encourage “structured investigative protocols” ( a pretty broad term) as a way of treating Stage I operable NSCLC in order to get more data. These conclusions are consistent with our own experience and we’re very encouraged that this treatment is rapidly gaining acceptability. The exact wording of the summary was:
” In the medically inoperable setting, we conclude that SBRT is an accepted treatment option for Stage I-II NSCLC. In the operable setting, we conclude more study and longer follow-up is necessary to ensure that results are equivalent to those of surgery. Ideally, medically operable patients with Stage I lung cancer would likely receive SBRT on a structured investigative protocol.”
While the report is lengthy, it can be read HERE
The CyberKnife Coalition - 2010 Membership Matters Campaign
March 25th, 2010
Visit the CyberKnife Coalition booth during the March 25th-27th CyberKnife Society Scientific meeting, to learn more about becoming a member and how the CKC works on your behalf to:
- Ensure Equitable Reimbursement
- Maintain and Expand Patient Access Through Medicare and Commercial Payer Coverage
- Provide Patient and Member Resources with Web Seminars, Online Tools and Consistent Communication
Person in the News
March 11th, 2010Hevezi Appointed to CMS’ MEDCAC Group
James Hevezi, Ph.D. past chair of the AAPM Economics Committee, has been appointed to the new Medicare Evidence Development and Coverage Advisory Committee, an advisory group to the Centers for Medicare and Medicaid Services. The MEDCAC will be used to supplement CMS’ internal exptertise and ensure an unbiased and contemporary consideration of innovative technology and science as grounds for reimbursing Medicare/Medicaid providers. Hevezi’s term began on January 1, 2010 and runs for 2 years, renewable if the MEDCAC group is renewed. The first meeting of the group will be held in Washington DC and evaluate the various radiotherapy methods of treating prostate cancer.
Hevezi is the current Chair of the ACR’s Commission on Medical Physics and serves on the ACR Board of Chancellors. His nomination to the post was supported by AAPM, ACR and ACRO. He is a fellow oif the AAPM and the ACR.
Source: AAPM Newsletter March/April 2010
