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RAD notes III (radiation therapy)

PETER O’CONNOR
Contributing Columnist
oconnor@lbknews.com

We’ll continue my journey, still in note format, from Week 7 through the completion of my Radiation Therapy in Week 9 +.  It has been a privilege to have you, my readers, along.  I trust that someone has learned something useful to himself, or a loved one. That has been our purpose.

 

Week 7 (4/1/13)  

Maggie here to derive me.  Radiation staff is a bit ahead of schedule.  Children appear to assist – increased concern which is both appreciated and understood.  Hopefully not required for this course of treatment; we all hope.

Tuesday an early morning call tells me that the radiation machine at Lakewood Ranch is down ‘for a while’.  I’m to wait at home for another call.  This is my 30th session and the first equipment delay I’ve encountered – pretty good performance.  Second call says come out tonight at 8:00pm.

Turns out hat the outage was minor as Maggie and I arrive this evening..  Late finish; not a great day.

Saw Dr. Sylvester after session # 31.  This out of planned 45 treatments.  I learn that the minimum time between radiations is 6 hours.  Some patients do ‘doubles’ or multiple sessions in a day – to shorten the time devoted to this treatment, e.g. those who come here from afar.

Heavy rain on Thursday morning.  Radiation goes ok, #32.

Completion of my 7th week on Friday with my 33rd treatment.  Staff ahead of schedule today.  My Driver, Maggie leaves for Boston this afternoon.

As we approach the end of treatment I thought that some discussion of what’s next might be in order.  The following is from NYU.

How do you know if the prostate cancer is “cured” after radiation therapy?

Just as after radical prostatectomy, the PSA is the best measure of disease control after radiation therapy. The PSA typically is undetectable after radical prostatectomy, since the entire prostate is removed. Low levels of PSA are often detectable after radiation therapy because it is not feasible to totally eradicate the prostate with radiation without destroying adjacent structures. Therefore, a measureable PSA after radiation therapy does not necessarily indicate residual prostate cancer.

Recurrence after radiation therapy is typically defined as a PSA level 2.5 ng/dl above the nadir (lowest) PSA level measured after treatment. It should be noted that a biochemical recurrence after radical prostatectomy and biochemical recurrence after radiation have very different clinical connotations: a biochemical recurrence after radical prostatectomy simply implies the presence of some residual disease, whereas a biochemical recurrence after radiation therapy portends a poor prognosis.           (NYU Langone Medical Center)

 

And on Costs, from Mount Sinai in New York

NEW YORK, Feb. 15, 2013 /PRNewswire/ — “Staying ahead of the curve often comes with a price. In the case of prostate cancer, treatment innovations fuel ongoing debate over the cost-benefit analysis of new technologies and modalities. In an institution-based study led by Dr. David Samadi, Vice Chairman, Department of Urology and Chief of Robotics and Minimally Invasive Surgery at The Mount Sinai Medical Center in New York, Robotic-Assisted Laparoscopic Prostatectomy (RALP) was found to be less than half the cost of radiation.

Focused on localized prostate cancer treatments from 2005 to 2009, researchers compared Mount Sinai hospital expenses for open prostate surgery, robotic surgery, brachytherapy seed radiation, Intensity Modulated Radioactive Therapy (IMRT), and a combination of brachytherapy and IMRT. Among the findings presented by Dr. Samadi at the European Association of Urology 27th Annual Congress in Paris last February, was a savings of more than $8,000 per RALP procedure over IMRT radiation.

Median cost comparison for prostate cancer treatment options:

 

• Brachytherapy:  $7,560

• Robotic prostate removal surgery:  $7,676

• Open prostate removal surgery:  $8,991

• Radiation therapy (IMRT):  $15,929

• Brachytherapy/IMRT combined for high-risk patients: $22,447”

Note that these are rather old data.  I’ll try to present my own costs in this piece.  These numbers are hard to come by.

Some  words about my costs;  I’ve been interested in learning a bit about the cost, both individual and National of all this treatment.  So far I find these numbers to be elusive.  There is plenty written about the “excessive” costs of treating all those with prostate cancer.  I’ll not go there now.  Obviously it is rather easy to aggregate the Medicare costs for the applicable diagnostic codes.  I’ve read that costs for prostate cancer can be 10% of the costs of treating all cancers. I’m trying to confirm that estimate, without success.  So, I’m working on the task of adding up the costs for one individual.  This is also elusive. In my case I can approximate the costs of pre-radiation treatment. These are for Urologist visits, lab tests, biopsy, more visits, Radiation Oncologist visit, radiation pre – imaging, radiation simulation (planning).  My reckoning so far is $16,098 billed, with $5,744 approved (by Medicare & Tricare).  In my case as a Tricare for Life subscriber the approved number equals the amount paid.  I’m left whole.  I didn’t yet see any actual radiation billings. * I’ve found some of these for this report.  These are huge numbers.  Extrapolating from the EOBs (Explanation of Benefits) in hand I can rationalize a total billed for MY radiation as $119,380, the amount allowed as $30,735. These are low but good discussion numbers.  To these must be added the costs of follow-on care with Urologist, tests, Radiation Oncologist for the next year or so.

My tally:

Billed Allowed (Paid)

$ 16,098 $  5,744

$119,380 $30,735

$   1,000 $    800

$136,478 $37,279

Note that I said the Mt. Sinai data above was old data.  My numbers are real data for one patient in this area. The $37,000 cost to the individual or his insurer is a commonly accepted number.  As I said, these are huge numbers.

Week 8 (4/8/13) Spring is here.  I’m driving myself again.  Saw Dr. Sylvester today.  He reviews every patient’s radiation results every day and sees each of us every week. That’s reassuring.  On rectal balloons – cost to them is $50 to $60 apiece. This added cost increases the level of care significantly.  Feeling fine on days 34 and 35.   Seems we had some delay on Tuesday as the duty doctor wasn’t present.  There has to be a physician present at the site when radiation treatments are given.  Remainder of this 8th week is routine.  The Rad Car is in action these dry mornings (40 miles round trip).  I’ve completed 38 sessions; that’s 84% of my planned radiation.   All ok,  on time, on target..  Still looking for some cost information.  Another patient, retired Army, suggested that this outfit, 21st Century Oncology, may be working to a negotiated Medicare rate.  We’ll see. It ain’t cheap, that’s for sure.

 

Week 9 (4/15/13) 

Starting the final full week of radiation treatment with session # 39. Routine this Monday.  I’ll try to make the LBK Commission Workshop this afternoon – feeling better.  Uneventful treatment for two more days.  I recall that we are fortunate to have this fine service available in or home area. We are lucky in Sarasota/Bradenton – a medical mecca of sorts.  Slight delay of Friday – a small computer glitch worked around by staff.  This is very sophisticated stuff.

Nine weeks is the proscribed course of treatment; 5 days/week X 9 weeks = 45, the magic number of treatments to get to the total radiation dosage needed. We talked about some of this clinical stuff in my opening column on this subject.  In my case this will actually take 2 days into the 10th week due to calendar variation.  So, I have Monday and Tuesday of the week of 4/22 to go.

Then it really is c’est finis;  I sincerely hope.  Merci.

 

 

 

 

 

 

 

 

 

 

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