Thursday, February 07, 2008

Vying For Big New Cancer Centers

Vying For Big New Cancer Centers
Silicon Valley / San Jose Business Journal - by Sara Solovitch
February 1, 2008

In the cancer treatment business, proton therapy is a subject you can hardly avoid.
The lucrative cancer treatment offered now at only five proton therapy centers in the U.S. is fast moving to the center of a heated debate about limited health care resources.

With another 25 or so of these $140 million behemoths in development, and ongoing discussions about the desirability of building one at virtually every academic medical center in the country, it's no surprise that several are being contemplated in the Bay Area.

Both Stanford University and the University of California, San Francisco are among those in the early stages of thinking and planning, and plans for another in Vallejo have been announced.

"We are seriously investigating the feasibility of it at Stanford," confirms Paul Keall, associate professor and director of the radiation physics division at Stanford Hospital and Clinics.

"There's no shortage of patients, the centers that exist have waiting lists, so from a cost recovery point of view it does make business sense. But," he adds, "with that price tag it's also a little intimidating."

Proton therapy uses a nuclear particle accelerator to shoot protons at nearly the speed of light into cancer tumors. Proponents say proton beams are the gold standard, particularly when it comes to pediatric cancer: proton beams are more precise than the X-rays typically used for radiation therapy because they can be given at higher doses with fewer side effects and a higher cure rate.

But many question the value of building one of these expensive, football-sized facilities as a way of treating various other cancers, including prostate, for which it's heavily marketed by Loma Linda University Medical Center in Southern California.

"I think the proton machine is in general overrated and too expensive," asserts Dr. Mack Roach, professor and director of radiation oncology at UCSF.

"There's been a big surge of interest in proton beam therapy recently because of reimbursement strategic advantages," he continues. "It's driven by the business model, not by any evidence of clinical need."

Though UCSF has been engaged in talks about building a proton center for two years, Roach says the center -- most likely to be situated at the new pediatric hospital site in Mission Bay -- will be more modestly geared towards cancer in children.
Traditional radiation therapy plays havoc in children, destroying surrounding, healthy tissue and often resulting in growth delays and learning problems. The problem is not nearly so critical, according to Roach, for adults.

Talks at Stanford, meanwhile, are at an even earlier stage of development, though physicists at the Stanford Linear Accelerator Center (SLAC) acknowledge they have had several discussions with representatives from the hospital.

Though the medical center would reportedly prefer to see a future proton therapy center situated on its own site, available land is so limited that there is a strong possibility that it might be located on SLAC property.

"SLAC has the accelerator and the physicists, and the hospital has the radiation oncologists, so Stanford is in an enviable position," says John Seeman, assistant director of Particle Physics and Astrophysics at SLAC. "The land SLAC is on belongs to Stanford, not the Department of Energy, and it would be fairly easy for Stanford to negotiate with the DOE."

SLAC is a Department of Energy laboratory, operated by Stanford. There are five accelerators currently running full-time at the Menlo Park facility, which is composed of a series of tunnels and support buildings, tightly controlled with hundreds of safety procedures, interlocks, guards, and a water-cooling plant -- all located about a mile from Stanford Hospital.

On April 18, SLAC is hosting a seminar devoted to the subject for the university at large. Nevertheless, discussions are so preliminary that physicists stress that even if the university and U.S. Department of Energy were to give the green light today, an operating facility wouldn't likely be up and running for another 15 years.

Meanwhile, business leaders project that there will be at least 50 proton centers operating across the U.S. within the next 10 years.

"If you run the math, 800,000 patients get radiation in any given year and of those at least 250,000 would benefit from proton therapy," says Hadley Ford, CEO of ProCure Treatment Centers Inc., a privately held company based in Bloomington, Ind., that oversees all aspects of construction.

"A lot of institutions would be well served by calling us," he offers. "We go out to doctors' groups, community hospitals, academic medical centers and say, 'Would you like a proton center for your hospital?'

"We take care of everything: the building design, the construction equipment, oversight, training, financing. We'll even put our own money in there. It is a complete turnkey outsourcing solution."

The company, founded in 2005, was the brainchild of John Cameron, who, as a former physics professor at Indiana University, played a pivotal role in the building of the Midwest Proton Radiotherapy Institute.

Ford allows that there are "probably half a dozen institutions up and down the Bay Area" interested in proton therapy. One interested party is a little-known New York institution called Touro College, which last November announced plans to build a university campus in Vallejo, and finance it with a proton therapy center.

But Touro has one big disadvantage in Vallejo: the lack of a steady source of patients. To help resolve that problem, the college has been in talks with UCSF to discuss some kind of collaboration.

The first proton center in the country was developed at Loma Linda, which treats between 900 and 1,200 patients a year.

Dr. James Slater, vice chairman of the Department of Radiation Medicine, says the number could be significantly more if it weren't for the 20 or 25 minutes it takes to position each patient inside the machine.

With that savings in mind, Loma Linda recently invested in a robot to do the job more efficiently.

"We can easily double -- if not more than double -- the number of patients," says Slater. "There's no limit on the number of patients, by any stretch of the imagination."

Loma Linda has waged a robust advertising campaign to market its proton center and, perhaps as a result, two-thirds of its patients come from outside its catchment area. Patients come from every state in the U.S., and many come from countries throughout the world.

Says Slater: "We treat primarily localized cancers that haven't spread throughout the body, from the brain, eye, head and neck cancers, some lung, early breast -- we plan to expand that in the next few years, to spinal cord, prostate, and children's. Not bowel. But we do do liver. I think the indications will be growing."

A support group of 3,000 men who call themselves the Brotherhood of the Balloon advocate on behalf of proton therapy, crediting it with their survival of prostate cancer.

But Roach and many radiation oncologists challenge that assumption and the rush to proton therapy.

An article published last year in the Journal of Clinical Oncology concluded that proton therapy showed no cost effectiveness over traditional radiation or brachytherapy, the method of implanting seed.

"You can put just as much radiation in [prostate] cancer using other technologies for a fraction of the price," says Roach, one of the leading experts on prostate cancer.

"But because of aggressive marketing tactics, you've got health care costs in this country that are spiraling out of control. And it's because of the ability of marketing people to convince the public that this is something that they need."

Sara Solovitch covers health care and biotech for the Business Journal. You can reach her at (408) 299-1841.

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