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Redefining Cancer Care Today's technologies are making tomorrow's cancer a chronic -- but not necessarily fatal -- disease
But cancer probably won’t kill you. "I see a time when many cancers that are fatal today will instead be chronic," says Levy, president and CEO of Varian Medical Systems in Palo Alto, Calif. "Patients will be periodically screened for recurrences or metastases and treated quickly and efficiently." Like cosmetic surgery patients getting occasional facelifts, cancer patients will come in for "touch ups," he says. What will make this possible are newer technologies such as intensity-modulated radiation therapy (IMRT), image-guided radiation therapy (IGRT) and—the still-unattained "holy grail" of radiotherapy—dynamic adaptive radiotherapy (DART). Today, IMRT and IGRT tools are targeting tumors more precisely to kill cancer with less damage to healthy tissue. Tomorrow, physicians using DART will tailor therapy like a well-fitting suit to precisely fit each patient. In this way, every course of treatment will be "personalized" to specific patient needs and changes in clinical circumstances. Costs, meanwhile, will be controlled through greater efficiency and expertise. "The first priority is taking the technology that exists today and using it more effectively and more routinely," says Levy, who’s been with the Varian family since 1968. Currently, radiation therapy technology is a Tower of Babel. According to Levy, there are three brands of linear accelerators and numerous treatment planning systems on the market. No two hospitals have precisely the same set up, so it’s difficult to establish treatment standards. It is possible, says Levy, that professional associations will eventually develop software standards so that mixed-and-matched technology in the radiation oncology department will communicate with optimum efficiency. But that day hasn’t arrived. So, to offer patients the best care possible in the current environment, Levy believes the best solution is a suite of fully compatible equipment from a single manufacturer. "That’s a controversial view," he says, "but the reality is that it’s currently not always possible for other treatment planning system vendors to keep up with advances we’re introducing into the treatment delivery sphere. For example, when we added the On-Board Imager device to our linear accelerator, many treatment planning systems other than ours couldn’t interface with it. Levy compared it to the old method of assembling a stereo system: You bought a tuner from one manufacturer, a turntable from another, a tape deck from a third and, possibly, a CD player from a fourth. Eventually, manufacturers were forced by consumer demand to provide integrated systems. Radiation therapy technology is following a similar path, says Dow R. Wilson, president of Varian’s Oncology Systems business. "There is a vast amount of technology integration happening now in radiation therapy that wasn’t happening in the past," he says. Varian, for instance, now offers a linear accelerator with on-board imaging, cone-beam CT and treatment planning. Integration is also easier on the patient. "With integrated products, patients get faster access to advanced cancer treatments based on more accurate planning, better targeting and more precise dose delivery," says Wilson, adding, "If you kill a tumor with 10 treatments, you don’t need to do the 11th." Compounding the compatibility problem is the "habit" of many hospitals to view technology acquisition as a simple purchase that, once paid off, is over. "The old paradigm was that people would keep equipment for 10 years," says Levy. "But in the software age, things change every 12 months." What this means, he adds, is that health care institutions must partner with suppliers to take full advantage of the continuing flow of updates and enhancements. The independence and reimbursement concerns of U.S. health care providers has, so far, discouraged this sort of approach, though it has been embraced by the United Kingdom’s national health service. In the meantime, says Levy, a huge amount of technology is not used optimally in every situation. "Our biggest challenge is to make it simple," he says. "With our integrated solution, our customers receive capabilities that minimize process steps. This simplicity takes out the variability in the treatment, delivers great patient care and enables departments to utilize resources more efficiently." Costs should fall as well. "The total cost of ownership is dependent on how many patients can be treated and how much manual intervention is required," says Levy, who estimated that an efficient, integrated department can treat four or five patients per hour with IMRT. Efficiency—and, therefore, costs—should improve. In addition, reimbursement for IMRT and IGRT are higher than for traditional radiation therapy. That may decline as the technology becomes more widely available, says Levy, but won’t wipe out the savings achieved by reduced complications and greater survival. The upshot of these multiple advances in radiation therapy? Levy sums up tomorrow in a few short but powerful words: "The future is very exciting."
October 2005 |
Dick
Levy sees the future of cancer treatment and it looks like…well, like kidney
dialysis or, perhaps, getting a new prescription for eyeglasses. In this
possible future, cancer treatment will be mostly a nuisance. It may have some
uncomfortable side effects. It will interfere with your schedule.