A skin cancer.
A skin cancer. Prof. Abraham Kuten, director of oncology at Haifa’s Rambam Medical Center, says the new treatment is dangerous, because “any mistake in the area hit by radiation could cause terrible damage.” Photo by Archive
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Israel shouldn’t purchase a new technology for treating cancer just yet, but should plan to do so sometime in the future, a panel of oncologists recently advised the Health Ministry.

The new radiation treatment, which is already used in 41 countries, is capable of aiming protons directly at the DNA of cancerous cells, while doing minimal damage to nearby healthy cells. This means it could have fewer side effects than previous radiation treatments, because the likelihood of damaging healthy cells is lower.

In 2010, the same advisory committee recommended against purchasing the machine, deterred in part by the $100,000 price tag. It said the scientific evidence to date didn’t justify the investment. But a few months ago, it was asked to revisit the issue, due to the growing number of Israelis who are flying overseas for the treatment.

The committee reiterated its finding that based on the available evidence, the new machine doesn’t deserve high priority. And while such a machine should be purchased sometime in the future, it continued, the acquisition should be a joint venture between the public health system and academia; the technology should not be bought by a private hospital, the panel insisted.

The committee, whose conclusions must still be approved by the Health Ministry, based its report largely on research done by ASTRO, the American Society for Radiation Oncology. In 2009, ASTRO found that aside from a few relatively rare types of cancer that occur mainly in children, the new technology is no more effective than already available treatments.

The Israeli panel, headed by Prof. Abraham Kuten, director of oncology at Haifa’s Rambam Medical Center, said that since the advanced radiation machines now used in Israeli hospitals are more accurate than older models, the chances of damaging nearby healthy cells are already low. Moreover, he said, the new treatment is dangerous, because “any mistake in the area hit by radiation could cause terrible damage.”

Aside from the high purchase price of the machines themselves, treatment sessions that employ the machines costs twice as much as current treatment sessions. Thus at this stage, the committee said, it would be cheaper for the state to finance treatment overseas for those few patients whose cancers genuinely require the new technology than to buy and run such a machine in Israel.

Some 24,000 Israelis a year are diagnosed with cancer, and about half of them undergo radiation treatment in Israel. To date, the Health Ministry has authorized overseas proton-radiation treatment for fewer than 10 children.

National radiation center

For the future, the committee proposed establishing a national proton radiation center, to which all doctors in Israel would have access. It would be a mistake to allow private hospitals to purchase the machines, the panel said, because that would “cause medical personnel to move to the private institute and increase the national expenditure on healthcare.”

Prof. Benjamin Corn of Tel Aviv’s Ichilov Hospital said he actually considered purchasing one of the new machines for his hospital, but ultimately decided to buy more advanced models of the older machines. “For the most common types of cancer, such as breast and prostate cancer, it’s hard to justify use of the proton machine,” he explained. “On one hand, if we bring the machine into Israel, it will create ethical dilemmas, because all patients will want to be treated on this advanced machine.

“But if we decide not to import it, society will have to spend $300,000 to $400,000 on every family whose child has a cancer that requires treatment by the new technology. Apparently, there’s no place for this technology yet, but it’s important to keep monitoring the issue.”

While some oncologists are waiting for the price of the new machines to drop, others are already working on plans to establish the national proton radiation center. Medical physicist Albert Schlocker has formed an organization to promote the new technology, and has been meeting with policymakers on the issue for four years already. He says he believes 1,000 Israelis per year would benefit from the new treatment.

In 2006, a state comptroller’s report found that due to lack of equipment and manpower, the average wait for radiation treatments in Israel was six weeks, with some patients waiting as long as four months. But since then, the Health Ministry said, hospitals have installed additional machines and been given funding for 50 new radiologists.