Proton therapy, a highly effective but costly way to treat cancer, is a missing link for Tampa Bay’s health care system. A consortium of high-profile organizations aims to change that.
Tampa Bay is the only major metro area in Florida without a proton therapy treatment center. “A what?” you ask.
Proton therapy has, over the past few years, become a popular alternative to conventional radiation treatment for cancer. It’s particularly useful when a cancerous tumor is close to a vital structure such as the heart, brain stem or spinal cord, because it allows beams of high-energy protons, as opposed to photons, to precisely target cancer cells while ignoring healthy tissue. The therapy has also been shown to be the safest way to treat pediatric cancer patients.
If that all sounds like something from Dr. McCoy’s lab on the starship Enterprise, well, let’s just say the future is now. But it’s not cheap. A proton therapy treatment center can cost more than $55 million, says Dr. Arie Dosoretz, managing partner at Advocate Radiation Oncology in Fort Myers, which is in the process of developing a proton therapy facility.
The consortium of health care providers that’s bringing proton therapy to Tampa — Florida Cancer Specialists & Research Institute, Florida Urology Partners, Proton Therapy Partners and Tampa General Hospital — isn’t saying how much their facility will cost, as it’s still in the planning stages. But officials at those entities do boast it will fill a major gap in the region’s health care offerings, in addition to bringing a new revenue stream to the providers.
Nathan Walcker, CEO of Fort Myers-based Florida Cancer Specialists & Research Institute, categorizes proton therapy as “bleeding edge” technology but says it has been around longer than many people might realize.
‘Proton therapy is the most sophisticated and advanced treatment that we have to offer, as far as radiation oncology and radiation treatments go.’ Dr. Richard Tuli, USF Health Morsani College of Medicine
“It’s been cost-prohibitive,” he explains. “Across the country, proton therapy centers have been constructed and incubated, but what hasn’t followed behind that is the reimbursement landscape. But for this team, the timing is perfect. We have a really elegant solution to come together and understand the structure that will make it successful.”
Dr. Richard Tuli, chief of radiation oncology in the USF Health Morsani College of Medicine at USF and Tampa General Hospital, says that, in addition to cost, the absence of a cohesive team approach to proton therapy contributed to the treatment’s local unavailability. The proton therapy machines themselves weigh between 50 and 200 tons and require specialized training to operate.
“Proton therapy is the most sophisticated and advanced treatment that we have to offer, as far as radiation oncology and radiation treatments go,” Tuli says. “However, at the end of the day, it is still a tool that needs to be appropriately used. Our care is most effectively delivered when it's given in conjunction with all members of the treatment team — radiation oncology, medical oncology, surgical oncology — and this partnership really allows us to effectively bring access to our patients in the community.”
That last point, about access, is key: According to a news release, a course of proton therapy can require 30 to 40 doses, sometimes as frequently as one dose per day, so proximity to an accredited facility is crucial to patients’ prospects for survival. Today, those patients are leaving the Tampa Bay area to receive treatment, sometimes for days at a time, so there’s a solid business case for providing a service that will keep them close to home and minimize disruptions to their daily routines. Other proton therapy centers in Florida are in Jacksonville, Orlando and the Miami area.
“This is a much-needed technology for the Tampa Bay region,” Tuli says. “We have All Children’s Hospital in St. Petersburg, and some of those patients currently travel across the state and often out of state, away from their families, to get these treatments.”
There are just 36 proton therapy treatment centers in the United States, so the importance of landing one can’t be understated. And the project, expected to break ground in the first quarter of 2022, with a construction timeline of 18 to 24 months, comes at a time when the region’s population is booming.
To that point, Walcker believes the proton therapy facility and its ancillary benefits — such as a robust boost to clinical research capabilities — will not only drive job growth, but “bring the best and brightest” to the region. “This is another feather in the cap for the local municipalities,” says Walcker, himself a transplant from New York.
While having four major medical organizations involved in the development of the proton therapy treatment center could be construed as a case of having too many cooks in the kitchen, there will be a clear division of responsibilities. The center will operate under the auspices of the Cancer Institute at Tampa General Hospital, with management services provided by Proton Therapy Partners, which, according to Walcker, “has a tremendous amount of expertise and a great track record of building proton therapy centers and operating them. We'll be looking to them to provide many of the traditional management services. Examples of that are product development, construction management, clinical and administrative operations training, education, IT infrastructure, revenue cycle, treatment planning and beyond.”
The facility itself, Tuli adds, “will likely be in South Tampa on the Tampa General Hospital medical campus. The physical footprint is going to be quite significant and will require construction of an entirely new facility. The details are still being finalized.”
Dosoretz says his firm’s proton therapy treatment center is a little further along in the development process. Its proton therapy machine is being built in Belgium, while the building that will house it is expected to open sometime in 2023.
“I wish it were [opening] tomorrow, but we’re shooting for 2023,” he says. “The worst-case scenario would be 2024. It’s a bit of a moving target, but I'm extremely confident we'll be the first proton therapy center on the west coast of Florida. Pretty soon, we should be able to announce some specifics.”
Financially, Advocate Radiation Oncology is taking a different approach than the Tampa consortium, raising funds from a mix of private and institutional investors. Despite the high-tech nature of the project, Dosoretz says it’s a relatively easy sell.
“You make a product that’s in demand,” he says. “You don't make a product and then try to create the demand. We have a huge incidence of cancer in Southwest Florida, so there’s huge demand for this service. We have a lot of patients that would benefit from this technology. We're already treating a lot of these patients.”
He adds, “If I took a small percentage of the patients we're treating today at Advocate and allocated a small percentage of them to the proton center, we could easily fill the center. So, there’s not a tremendous amount of risk on the demand side.”
Advocate, Dosoretz says, has factored in the potential for future growth stemming from the demand for proton therapy. Plans for its facility call for not one, but two, of the 5,000-square-foot rooms, known as bunkers, that house proton therapy machines.
“We want to make sure nobody’s missing out on something that could help them,” he says.
From a business perspective, the most exciting aspect of the facility, Dosoretz adds, is the “halo effect” that comes with such a rare, prestigious amenity.
“I think about the halo from so many different angles,” he says. “Job creation, medical research, the hospitality industry. Patients will travel to this area for treatment and there will be some benefit to the hotels.” It will also be a magnet for experts from other markets, like Walcker, who are eager to make their mark at a brand-new proton therapy facility.
The project brings an enormous sense of pride to Dosoretz, a third-generation radiation oncologist who grew up in Southwest Florida before heading to the University of Pennsylvania for medical school. He says he could have stayed in the Northeast and pursued opportunities at medical facilities in much larger markets, but felt a duty to use his education and expertise to improve the community that helped propel him to success.
“We’re not a big corporation looking at a map and asking, ‘Where can we make the most profit?’” he says. “We’re looking at this from the ground up, at all of the potential benefits. That’s what good businesses should do — develop a good product that’s going to benefit people, and then try to help as many people around you as possible. That’s part of your civic duty.”