£20m Damages Case May Change Insurer Funded Cancer Treatment Options

A court case in the United States which ended in a £20 million damages award for the family of a patient who died from cancer after being denied proton beam therapy (PBT) has highlighted the importance of recognising PBT as a well-established treatment.

The verdict by the court in Oklahoma could have significant ramifications for proton beam therapy and the way it is selected for cancer patients.

Orrana Cunningham, who had stage 4 nasopharyngeal cancer near her brain stem, was recommended proton beam therapy treatment by her doctors in 2014, a type of radiotherapy treatment which delivers heavily charged protons with a high degree of accuracy to minimise damage to peripheral tissue and organs. Her insurance provider refused to cover the PBT treatment on the grounds that it was an ‘experimental’ treatment despite it being recommended by her oncologists.

Mrs Cunningham and her husband set about raising the money themselves but in May 2015, Mrs Cunningham died.

The jury said that the verdict is meant to send out a message and stressed that it was clear from expert testimony that proton beam therapy is not an experimental treatment and was medically necessary in Mrs Cunningham’s case.

The trial heard from multiple experts including Dr. Andrew L. Chang, an oncologist with over 12 years of experience treating patients with proton therapy. He stressed that proton therapy is not a new, experimental treatment and has been used to treat patients in the US for decades.

High energy PBT is, however, new in the UK and the first patient was treated at the Rutherford Cancer Centre South Wales in April. A further 25 patients have been treated or are in the process of being treated with PBT.

Around 250 people are diagnosed with nasopharyngeal cancer each year in the UK, a rare type of cancer that affects the part of the throat connecting the back of the nose. The NHS currently approves PBT for this cancer type but only in children.

Professor Karol Sikora, chief medical officer at the Rutherford Cancer Centre South Wales, currently the only clinic in the UK that provides high energy PBT, said the US verdict underlined the importance of recognising the treatment as well-established and effective.

“Nasopharyngeal cancer is a good example of a rare form of cancer which may be better treated with proton beam therapy and without resulting in harmful side effects.

“It is important to stress that proton beam therapy is not the answer for all types of cancers, and we at the Rutherford Cancer Centres maintain a strict policy of double planning to evaluate whether a patient is best served with PBT or conventional radiotherapy. In fact, we have treated more patients conventionally. That said, proton therapy has been around for a long time now internationally and knowledge of its value as a treatment will grow in the UK.”

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