Sibley’s proposed $130 million facility would open in 2017, taking up one-third the size of a football field. MedStar Georgetown’s slimmer $32 million center could begin operating next year at the Lombardi Comprehensive Cancer Center. Neither project can move forward without a go-ahead from D.C. health planning officials.
The contest is part of the increasingly heated battle for dominance and raises fundamental questions about health care today: how to balance innovation and cost, and how to determine whether one treatment is better than another.
Executives at MedStar Georgetown and Sibley, as well as other experts, generally agree that proton therapy’s greatest potential is in treating children, particularly those with brain and eye tumors. The therapy can be administered at higher doses than conventional radiation and causes fewer long-term side effects.
But they also acknowledge that research has yet to demonstrate that the treatment is better than conventional therapy for other cancers, such as prostate, even though many hospitals want to use proton therapy to treat that disease.
The first hospital proton beam center opened in 1990 at Loma Linda University Medical Center in California. Today, 11 proton facilities are operating in the United States, and at least 17 more are under construction or in development, including one at the University of Maryland in Baltimore that is set to open in two years, according to the National Association for Proton Therapy.
“One of the things that comes across is the fact that proton therapy is not as useful as it is said to be, that it is basically an arms race between different hospitals,” Amha Selassie, director of the independent D.C. State Health Planning and Development Agency, said at a public hearing in January. He will decide on the MedStar Georgetown and Sibley applications, and could approve one or both or deny both.
Some experts say the rush to embrace the technology is misguided.
“So why is the venerable Mayo Clinic building two proton beam facilities? Because it’s competing against Massachusetts General Hospital, M.D. Anderson in Texas, the University of Pennsylvania, Loma Linda in California — all of which have one,” former White House adviser Ezekiel J. Emanuel, an oncologist and vice provost at the University of Pennsylvania, wrote in an op-ed in the New York Times last year.
Hospitals using proton technology get higher Medicare reimbursements than those using conventional radiation — for example, $32,000 per patient compared with less than $19,000 for prostate cancer treatment, according to a recent study in the Journal of the National Cancer Institute.