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PaulB Offline OP
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Thanks Brian. Unfortunately, cancer aside, I will have no breaks for a while with HBOT, tooth extractions, hopefully dentures, and now with my left arm paralysis, which in my books, is nothing lol.

HBOT, 5th day. So far, it's the same as before. It lowers my BP somewhat, which was found to be very high, and blood glucose. I have to keep my glucose at a higher range since it can go from 130 to 105. No problem equalizing my ears, but makes me tired enough to take a nap when I arrive home. I brought a bunch of light hearted DVD's to watch, chose one, and was embarrassed when suddenly there was a sexy scene, cursing. I should have expected that with a movie titled, "The Matador." I thought they would tell me don't come back lol. Sticking to Seinfeld today.

Saw a neurologist yesterday for my shoulder issue. Nurse had to call the doctor in sooner since my BP was 193/130. It was funny when reviewing my history, after my first cancer, and treatment, the doctor thought that was the extent of it, but said, no, and continued on to the 2nd recurrence, and after that, thought the same, but said no again, and went to the 3rd to the 7th saying not finished yet lol, and when I said I have no carotid artery, the doctor did a double take to look at me, and when I finally finished, said , "wow!" My ENT did say to his colleague my last visit, my carotid was removed, and told me I'm one of the few people in the world walking around without a carotid artery. I guess that's why he calls miracle man.

Anyway, after my history, physical examination, mentioning possible brachial Plexopathy, the doctor said she thinks it's more than just that, and has to conduct some tests to have a better idea, so I'm scheduled to have an EMG and an EEG test next month.

Hope to have a blood test done tomorrow before HBOT, and see my oncologist next week about the high BP. I don't think they may do surgery with it so high? Have to schedule an appt. with the Oral Surgeon too, as far as surgery for the tooth (all) extractions, and was told by HBOT it usually is done immediately following the 4 weeks, which is the 21st of August, have extractions, and continue HBOT the next day lol. We'll see about that.


10/09 T1N2bM0 Tonsil
11/09 Taxo Cisp 5-FU, 6 Months Hosp
01/11 35 IMRT 70Gy 7 Wks
06/11 30 HBO
08/11 RND PNI
06/12 SND PNI LVI
08/12 RND Pec Flap IORT 12 Gy
10/12 25 IMRT 50Gy 6 Wks Taxo Erbitux
10/13 SND
10/13 TBO/Angiograph
10/13 RND Carotid Remove IORT 10Gy PNI
12/13 25 Protons 50Gy 6 Wks Carbo
11/14 All Teeth Extract 30 HBO
03/15 Sequestromy Buccal Flap ORN
09/16 Mandibulectomy Fib Flap Sternotomy
04/17 Regraft hypergranulation Donor Site
06/17 Heart Attack Stent
02/19 Finally Cancer Free Took 10 yrs






Joined: Jul 2012
Posts: 3,267
PaulB Offline OP
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Intensity Modulated Proton Therapy reduces the need for feeding tube by 50% in oropharyngeal patients.

http://www.proton-therapy.org/intensity_modulated.html


10/09 T1N2bM0 Tonsil
11/09 Taxo Cisp 5-FU, 6 Months Hosp
01/11 35 IMRT 70Gy 7 Wks
06/11 30 HBO
08/11 RND PNI
06/12 SND PNI LVI
08/12 RND Pec Flap IORT 12 Gy
10/12 25 IMRT 50Gy 6 Wks Taxo Erbitux
10/13 SND
10/13 TBO/Angiograph
10/13 RND Carotid Remove IORT 10Gy PNI
12/13 25 Protons 50Gy 6 Wks Carbo
11/14 All Teeth Extract 30 HBO
03/15 Sequestromy Buccal Flap ORN
09/16 Mandibulectomy Fib Flap Sternotomy
04/17 Regraft hypergranulation Donor Site
06/17 Heart Attack Stent
02/19 Finally Cancer Free Took 10 yrs






Joined: Jan 2013
Posts: 1,291
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[quote]MD Anderson researchers evaluated 25 OPC patients treated with IMPT and 25 OPC patients treated with IMRT as part of the study. Five patients treated with IMPT required the use of feeding tubes (20 percent) compared to 12 patients treated with IMRT (48 percent).[/quote]I'd not see a hard number assigned to people on PEGs.
I wonder if "required the use of feeding tubes" counts those having them inserted or those who actually used them? Do they count those getting them early then not using them?


Don
Male, 57 - Great health except C
Dec '12
DX: BOT SCC T2N2bMx, Stage 4a, HPV+, multiple nodes
1 tooth out
Jan '13
2nd tooth out
Tumor Board -induction TPF (3 cycles), seq CRT
4-6/2013
CRT 70gr 2x35, weekly carbo150
ended 5/29,6/4
All the details, join at http://beatdown.cognacom.com
Joined: Jul 2012
Posts: 3,267
PaulB Offline OP
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I would think the notation, "required the use of feeding tube..." means to have required the need to have used it for nutrition. It didn't say if they already had one inserted prior to treatment or needing one placed during treatment or if used solely, partially, as the only means for nutrition, but at some point it was required to use. It's a small study, but not surprising findings, to me.

The article also mentions an ongoing randomized phase ll/lll trial at MDAnderson during the next 5 years with IMPT vs IMRT.



10/09 T1N2bM0 Tonsil
11/09 Taxo Cisp 5-FU, 6 Months Hosp
01/11 35 IMRT 70Gy 7 Wks
06/11 30 HBO
08/11 RND PNI
06/12 SND PNI LVI
08/12 RND Pec Flap IORT 12 Gy
10/12 25 IMRT 50Gy 6 Wks Taxo Erbitux
10/13 SND
10/13 TBO/Angiograph
10/13 RND Carotid Remove IORT 10Gy PNI
12/13 25 Protons 50Gy 6 Wks Carbo
11/14 All Teeth Extract 30 HBO
03/15 Sequestromy Buccal Flap ORN
09/16 Mandibulectomy Fib Flap Sternotomy
04/17 Regraft hypergranulation Donor Site
06/17 Heart Attack Stent
02/19 Finally Cancer Free Took 10 yrs






Joined: Jul 2012
Posts: 3,267
PaulB Offline OP
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Proton news, insurance coverge...Interesting, Indiana University's Proton Center is closing, and one way to have Proton Beam covered is through a Clinical trial like MDAnderson's. I don't know if the articles will open, but can be searched.

http://www.kaiserhealthnews.org/Stories/2014/September/23/Insurers-Hesitant-To-Cover-Many-Proton-Beam-Therapy-Treatments.aspx?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%253A+khn+(All+Kaiser+Health+News)

http://www.modernhealthcare.com/article/20140918/NEWS/309189939/as-a-proton-therapy-center-closes-some-see-it-as-a-sign%23


10/09 T1N2bM0 Tonsil
11/09 Taxo Cisp 5-FU, 6 Months Hosp
01/11 35 IMRT 70Gy 7 Wks
06/11 30 HBO
08/11 RND PNI
06/12 SND PNI LVI
08/12 RND Pec Flap IORT 12 Gy
10/12 25 IMRT 50Gy 6 Wks Taxo Erbitux
10/13 SND
10/13 TBO/Angiograph
10/13 RND Carotid Remove IORT 10Gy PNI
12/13 25 Protons 50Gy 6 Wks Carbo
11/14 All Teeth Extract 30 HBO
03/15 Sequestromy Buccal Flap ORN
09/16 Mandibulectomy Fib Flap Sternotomy
04/17 Regraft hypergranulation Donor Site
06/17 Heart Attack Stent
02/19 Finally Cancer Free Took 10 yrs






Joined: Jan 2013
Posts: 1,291
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Hi Paul,

Thanks for the links. The second link you post does not open but going via search I got to it. Below is the article text.

From this article it is hard to draw any conclusion on the state of PT. We all know it is costly as reiterated in the article and fewer insurance companies are authorizing such treatment yet more centers are being built.

Must be more to the story (financial) for such investments to be made unless they see profits somewhere. It does state exclusion for prostrate cancer but not others.



As a proton therapy center closes, some see it as a sign

By Jaimy Lee
Posted: September 18, 2014 - 5:15 pm ET
Tags: Costs, Indiana, Insurers, Medical Technology, Reimbursement

The Indiana University Proton Therapy Center will close in December, marking the first time a proton-beam therapy center in the U.S. has shut its doors since the rapid proliferation of the costly treatment centers began about a decade ago.

University executives and an independent review committee attributed the center's financial losses to a range of issues, including the cost of maintaining its aging cyclotron, but the committee also suggested the industry may be on the verge of a “proton bubble” as the centers struggle to serve a sufficiently large patient population.

Many of the centers have based their volume expectations on treating prostate cancer patients, but insurers have increasingly started to push back against providing coverage of proton therapy for these patients because of a lack of evidence proving superior benefits over other treatments.

Blue Shield of California and Aetna last year said they would no longer cover proton therapy as a treatment for localized prostate cancer. Cigna Corp. does not cover proton-beam therapy in the treatment of prostate cancer either.

“I look at this closure as a sign that insurers are finally empowered to say this is a dubious medical technology” in the treatment of patients with prostate cancer, said Amitabh Chandra, director of health policy research at the Harvard Kennedy School of Government. “The 'build it and they will come' philosophy around these centers is being questioned.”

The IU center, located in Bloomington, Ind., was the third in the U.S. when it first opened its doors in 2004. It's jointly owned by the Indiana University Research and Technology Corp., a not-for-profit that handles IU-related business development, trademarks and intellectual property, and IU Health, an Indianapolis-based health system that owns 15 hospitals in Indiana.

“Unfortunately, rapidly advancing technology and changes in the dynamics of cancer treatment have left us with a dwindling patient base and a facility that is many times more expensive to operate than most of our competitors in this field,” Dr. Jay Hess, vice president for clinical affairs and dean of the IU School of Medicine, said in a statement announcing the closure in August.

There are currently 13 proton centers, including the IU center, operating in the U.S. and at least 12 more facilities in development, according to the National Association for Proton Therapy. A facility can cost more than $200 million to build. Even the least costly proton centers still have price tags of around $30 million each.

When faced with the prospect of spending millions of dollars to update the IU center's equipment, the university called for an independent review of the facility.

The review committee unanimously recommended closing the center. In the committee's report (PDF), the reviewers highlight many of the issues affecting the proton industry as a whole, including the lack of completed randomized clinical trials, improvements in alternative treatments, changing care patterns for patients with prostate cancer, and the rise in new payment models, such as bundled payments, that may remove incentives to use the therapy.

“It is, therefore, quite possible that we are on the verge of a 'proton bubble' with the more indebted centers or those without a strong patient supply line closing,” the committee said in the report.

While proton therapy has been most widely used in the treatment of prostate cancer, it also can be used to treat lung cancer, pediatric tumors and cancers of the head and neck. Using protons to treat pediatric cancers, for example, is considered effective by many practitioners. Among the IU committee's recommendations was a suggestion that the hospital system consider building a single-room proton facility at the Riley Children's Hospital in Indianapolis.

“It became clear that there is no overriding drive to maintain this facility in the face of mounting losses and required investment to maintain operation,” the report said.

The losses and challenges were clearly outlined in the report. The IU center requires 63 people to staff the cyclotron, spelling high labor costs. The technology, which was adapted from a research cyclotron, needed a $30 million upgrade. The Bloomington site, which is an hour's drive from Indianapolis, is not ideal for clinical-trial participation because it requires most patients to travel.

The center reported a $3.5 million operating loss in fiscal 2013. Another challenge it faced: newer centers are expected to be opened by University Hospitals in Cleveland, Ohio, and by the Mayo Clinic in Rochester, Minn., key referral markets.

The closure will have “minimal to no impact on the proton community outside of Indiana,” said Leonard Arzt, executive director of the national association.

The IU center is not the only proton therapy facility to struggle financially. ProCure, a Somerset, N.J.-based private-equity operator of three proton centers, in 2013 sold its stake in a proton center in Warrenville, Ill., to its partner, Cadence Health, after undergoing a financial restructuring.

Some experts say they don't expect more closures. “I don't get that sense,” said Dr. James Yu, assistant professor of therapeutic radiology at Yale School of Medicine.

But he does anticipate more reimbursement pressure and pushback from insurers for proton treatments beyond prostate cancer.

“As insurers become more restrictive in paying for prostate, I hope they also become open and supportive of agreed-upon treatments rather than restricting proton treatments across the board,” Yu said.


Don
Male, 57 - Great health except C
Dec '12
DX: BOT SCC T2N2bMx, Stage 4a, HPV+, multiple nodes
1 tooth out
Jan '13
2nd tooth out
Tumor Board -induction TPF (3 cycles), seq CRT
4-6/2013
CRT 70gr 2x35, weekly carbo150
ended 5/29,6/4
All the details, join at http://beatdown.cognacom.com
Joined: Jul 2012
Posts: 3,267
PaulB Offline OP
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Don, thanks for posting the text. Seems to be lots if interest in the Proton subject with over 30,000 views, so just posted some recent news. I think they want to restrict more of Prostrate treatments as you say. Other reports mentioned some centers being built as prostrate mills. Where I went, I think there were more prostrate cancer patients than any other. They even received a nice white robe, and I didn't lol, but what they have to go through, I wouldn't want to do, but maybe some of it are just rumors.

I wondered how many employee's worked at some facilities, and 63 is a good estimate where I was, and seemed to be more staff than patients, but the facility was luxurious, top rate, very calming.


10/09 T1N2bM0 Tonsil
11/09 Taxo Cisp 5-FU, 6 Months Hosp
01/11 35 IMRT 70Gy 7 Wks
06/11 30 HBO
08/11 RND PNI
06/12 SND PNI LVI
08/12 RND Pec Flap IORT 12 Gy
10/12 25 IMRT 50Gy 6 Wks Taxo Erbitux
10/13 SND
10/13 TBO/Angiograph
10/13 RND Carotid Remove IORT 10Gy PNI
12/13 25 Protons 50Gy 6 Wks Carbo
11/14 All Teeth Extract 30 HBO
03/15 Sequestromy Buccal Flap ORN
09/16 Mandibulectomy Fib Flap Sternotomy
04/17 Regraft hypergranulation Donor Site
06/17 Heart Attack Stent
02/19 Finally Cancer Free Took 10 yrs






Joined: Jan 2013
Posts: 1,291
Patient Advocate (1000+ posts)
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I found another article with more detail
https://www.insideindianabusiness.com/newsitem.asp?ID=66750

In fact, 115 employees are losing jobs from the shutdown. 65 at med facility and 50 at the cyclotron. And doing 2000 treatments in 10 years. This must have been tough but easy (financial) decision.
Sounds like any technology. Obsolete the day you get it. Walk around the block and get gen 2 for half as much and does twice as much.


Don
Male, 57 - Great health except C
Dec '12
DX: BOT SCC T2N2bMx, Stage 4a, HPV+, multiple nodes
1 tooth out
Jan '13
2nd tooth out
Tumor Board -induction TPF (3 cycles), seq CRT
4-6/2013
CRT 70gr 2x35, weekly carbo150
ended 5/29,6/4
All the details, join at http://beatdown.cognacom.com
Joined: Jul 2012
Posts: 3,267
PaulB Offline OP
Patient Advocate (old timer, 2000 posts)
OP Offline
Patient Advocate (old timer, 2000 posts)

Joined: Jul 2012
Posts: 3,267


10/09 T1N2bM0 Tonsil
11/09 Taxo Cisp 5-FU, 6 Months Hosp
01/11 35 IMRT 70Gy 7 Wks
06/11 30 HBO
08/11 RND PNI
06/12 SND PNI LVI
08/12 RND Pec Flap IORT 12 Gy
10/12 25 IMRT 50Gy 6 Wks Taxo Erbitux
10/13 SND
10/13 TBO/Angiograph
10/13 RND Carotid Remove IORT 10Gy PNI
12/13 25 Protons 50Gy 6 Wks Carbo
11/14 All Teeth Extract 30 HBO
03/15 Sequestromy Buccal Flap ORN
09/16 Mandibulectomy Fib Flap Sternotomy
04/17 Regraft hypergranulation Donor Site
06/17 Heart Attack Stent
02/19 Finally Cancer Free Took 10 yrs






Joined: Jul 2012
Posts: 3,267
PaulB Offline OP
Patient Advocate (old timer, 2000 posts)
OP Offline
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Joined: Jul 2012
Posts: 3,267
Proton Therapy: Progress with a Price Tag

http://proton-therapy.org/dotmed_progress_sept_2014.html

Last edited by PaulB; 09-25-2014 06:12 AM.

10/09 T1N2bM0 Tonsil
11/09 Taxo Cisp 5-FU, 6 Months Hosp
01/11 35 IMRT 70Gy 7 Wks
06/11 30 HBO
08/11 RND PNI
06/12 SND PNI LVI
08/12 RND Pec Flap IORT 12 Gy
10/12 25 IMRT 50Gy 6 Wks Taxo Erbitux
10/13 SND
10/13 TBO/Angiograph
10/13 RND Carotid Remove IORT 10Gy PNI
12/13 25 Protons 50Gy 6 Wks Carbo
11/14 All Teeth Extract 30 HBO
03/15 Sequestromy Buccal Flap ORN
09/16 Mandibulectomy Fib Flap Sternotomy
04/17 Regraft hypergranulation Donor Site
06/17 Heart Attack Stent
02/19 Finally Cancer Free Took 10 yrs






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