Waiting for protons ... MDACC edition

[deleted1111261]

I feel like many of these articles focus on MDACC patients/providers.

Someone made the point about a nasopharyngeal case - why did they wait so long for treatment when a standard treatment was available? Why did they not just treat with protons and charge IMRT rates? I am very confused about why an MD would allow an aggressive cancer to go untreated. I can't imagine doing this. We are supposed to help these patients, and if standard of care is available, why not utilize it?

I don't think this is the first case noted. I think there are quite a few more. Maybe it is not just MDACC, but even waiting 2 weeks makes my skin crawl and keeps me up. 2 months? 6 months? How do you sleep at night?

Anyway, I wonder if I am missing some part of the story here - it is very possible some nuance is removed - PP tends to club you on the head rather than present an elegant story where all the pieces fit together snugly.

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[Ray D. Ayshun]

Didn't read details. Were they doing neoadjuvant chemo while waiting, or just waiting?

 

[ramsesthenice]

I feel like many of these articles focus on MDACC patients/providers.

Someone made the point about a nasopharyngeal case - why did they wait so long for treatment when a standard treatment was available? Why did they not just treat with protons and charge IMRT rates? I am very confused about why an MD would allow an aggressive cancer to go untreated. I can't imagine doing this. We are supposed to help these patients, and if standard of care is available, why not utilize it?

I don't think this is the first case noted. I think there are quite a few more. Maybe it is not just MDACC, but even waiting 2 weeks makes my skin crawl and keeps me up. 2 months? 6 months? How do you sleep at night?

Anyway, I wonder if I am missing some part of the story here - it is very possible some nuance is removed - PP tends to club you on the head rather than present an elegant story where all the pieces fit together snugly.

I never know what to think with these things. MDACC is a big place. I don't know a ton of faculty at MDACC but the ones that I do know are pretty reasonable folks that I don't see making someone wait to get a higher level of service. You always have to wonder if there is more to the story than what is presented.

I can think of a total **** show for me once. I asked for IMRT for a definitive esophageal case which was denied. Perfect storm of WTF. The patient was originally scheduled to see one of my partners who ended up taking a sick day which is how I ended up with them. However, the planning system still had them listed as the attending of record. So the denial information went to them and not me. It ended up getting dropped and I had no idea. I had 20 under beam and they were not on my immediate radar. I got thinks squared away within 24 hours of finding out what was going on. There was nothing malicious at all. But a great story could be spun to make us look like money grubbing douche lords who don't really care that much about our patients.

 

[Doctorer]

I shift part of the blame on the provider in this case. There was a somewhat similar case in the news from MGH a few years back, iirc a woman with a PA nodal recurrence of cervical cancer. In both cases, it's not a situation where I would feel comfortable sitting for weeks/months while writing letters/appeals/etc. Perhaps that's what the UM company is banking on, but I would want to get the patient on treatment.

Over the years, I've found it helpful to be less specific in situations like this with patients, even where I might want to use protons. Yes, I may try to get protons approved, but I wouldn't tell/imply to a patient that protons are the preferred treatment for their condition: I'm willing to call it an outright lie, although one I've heard my colleagues say.

 

[communitydoc13]

I feel like many of these articles focus on MDACC patients/providers.

Someone made the point about a nasopharyngeal case - why did they wait so long for treatment when a standard treatment was available? Why did they not just treat with protons and charge IMRT rates? I am very confused about why an MD would allow an aggressive cancer to go untreated. I can't imagine doing this. We are supposed to help these patients, and if standard of care is available, why not utilize it?

I don't think this is the first case noted. I think there are quite a few more. Maybe it is not just MDACC, but even waiting 2 weeks makes my skin crawl and keeps me up. 2 months? 6 months? How do you sleep at night?

Anyway, I wonder if I am missing some part of the story here - it is very possible some nuance is removed - PP tends to club you on the head rather than present an elegant story where all the pieces fit together snugly.

Good post. There may not really be badness going on here. It is interesting that the ProPublica articles emphasize the MDACC cases as they do.

There is irony here as the NP case is one where, to a practicing radonc, the info supplied seems like malpractice with a bad outcome on MDACCs part, even though the intent of the article is seemingly to paint the PA process and their malpracticing medical directors as the villains to the lay public.

 

[OTN]

I feel like many of these articles focus on MDACC patients/providers.

Someone made the point about a nasopharyngeal case - why did they wait so long for treatment when a standard treatment was available? Why did they not just treat with protons and charge IMRT rates? I am very confused about why an MD would allow an aggressive cancer to go untreated. I can't imagine doing this. We are supposed to help these patients, and if standard of care is available, why not utilize it?

I don't think this is the first case noted. I think there are quite a few more. Maybe it is not just MDACC, but even waiting 2 weeks makes my skin crawl and keeps me up. 2 months? 6 months? How do you sleep at night?

Anyway, I wonder if I am missing some part of the story here - it is very possible some nuance is removed - PP tends to club you on the head rather than present an elegant story where all the pieces fit together snugly.

Why did the MDACC radonc throw IMRT under the bus so hard in the interview with Pro Publica? Why, then, should we act surprised when the lay press subsequently describes radiation as "brutal"?

 

[winstonfoot5]

Why did they not just treat with protons and charge IMRT rates?

I thought this was fraud? (sarcasm)

 

[evilbooyaa]

I'm sure devil is in the details.

I really hope MDACC didn't make a NPC pt wait 4-6 months with NO therapy simply to get protons approved. I'm well aware of the catastrophic toxicities seen with 2D/3D-CRT for NPC and proton RT for NPC. Less aware of catastrophic toxicity of IMRT for NPC but I'm sure the feelings are quite strong at MDACC.

But unless Clifton Dave Fuller makes an account on SDN to explain the details better I can't imagine a way we'd actually figure it out. Even asking on Twitter would make him in a position (potentially?) given potential HIPAA concerns.

So, the PP article is all we get. Short (on details) and unsatisfying.