If proton therapy is a treatment option for your patients, one of the first questions they might ask is, ‘Does my insurance cover it?’
For Veterans who are receiving VA health care benefits, that answer is often yes. The Veterans Health Administration (VHA), following the American Society for Radiation Oncology’s (ASTRO) model policies for radiation oncology services, has identified that proton therapy delivers ionizing radiation to cancer, destroys tumor cells with greater precision and results in less radiation doses to surrounding normal tissue. As a result, proton therapy may be the preferred choice of treatment when healthy tissue sparing is of clinical benefit to the patient.
“Proton therapy makes cancer treatment tolerable by delivering higher doses of radiation to cancer cells while sparing healthy tissue and organs, minimizing side effects for patients,” said Hesham Gayar, MD, medical director of the McLaren Proton Therapy Center. “In turn, patients have higher cure rates and improved expectancy of a cancer-free, better-quality life after treatment.”
Due to VHA policy updates that were made in 2018, many Veterans across the country gained access to proton therapy. The memorandum sent to VHA network and facility directors says the decision for proton therapy treatments is determined by the VHA attending radiation oncologist in collaboration with a proton therapy specialist.
Two scenarios that the VHA might consider proton therapy treatment is when certain cancers require retreatment, or reirradiation, and when the minimization of a patient’s overall radiation dose is crucial for their health during and after treatment.
“Because proton therapy is targeted at the tumor and spares surrounding tissue, one of the advantages is that it can be used to treat cancer when a patient has been told nothing else can be done,” said Dr. Gayar. “If the patient has had previous radiation treatments, with proton therapy we can avoid reirradiation to the tissue surrounding the tumor that may not be able to tolerate more conventional radiation.”
The VHA also provides coverage for Veterans who participate in an approved clinical trial. Breast and prostate cancer clinical trials are two examples of when the VHA provides coverage for proton therapy treatments. The opportunity to participate in clinical trials through Karmanos Cancer Institute is available to McLaren Proton Therapy Center patients.
A list of cancer cases in which proton therapy is a beneficial treatment for any patient can be found here.
To refer a patient to the McLaren Proton Therapy Center, visit mclaren.org/protonforphysicians, or download the referral form.