HealthCare Business News recently spoke with Scott Warwick, the new executive director of the National Association for Proton Therapy to talk about his foray into the technology and updates on the sector. Here’s what he had to say.

HCB News: How long have you been involved with proton therapy efforts and how did you come to be the executive director of NAPT?
Scott Warwick: My background is clinical. I was originally a radiation therapist and then a certified medical dosimetrist before I moved into oncology administration.

In 2008, I worked for Catholic Health Partners serving as the regional cancer service line leader for the Tennessee region and also headed up the oncology leadership network for the organization. During that time, the executive committee of the board had become interested in proton therapy. They asked me for an analysis and to present an executive summary on proton therapy to the board and that’s where I really first became knowledgeable about proton therapy.

Fast forward a year. I was still serving in that role, but had started working on a collaborative project with our physicians and through that met the founder of Provision who invited me to join their efforts to develop a world-class comprehensive cancer center in Knoxville, Tenn. Early on, I shared that proton therapy was an emerging technology and that we should take a strong look at offering the service in Knoxville. After performing an in-depth proton therapy feasibility study and experiencing some roadblocks with adding conventional radiation therapy, it was determined that Provision would seek the first Certificate of Need for proton therapy in the southeastern U.S., which was received in 2010. The center opened on time and on budget in January of 2014 and was the 13th center to open in the U.S.

While we were developing the center at Provision, I became aware of NAPT and realized it had an expansive knowledge base that we could greatly benefit from. The problem at the time was that NAPT only allowed operating members to participate. We were in the development phase, so I approached the association and made a pitch for the creation of an associate membership for developing centers. They ultimately agreed and Provision became the first associate member of NAPT. We were then able to learn from existing experts in the field in a very collegial atmosphere that still exists in the association today. Later on, I joined the board, and then ultimately served as the board chairman. When the executive director position opened last year, I had been working to expand access to proton therapy on a regional level while at Provision and saw this position as an opportunity to do the same, but on a national level.

HCB News: It seems like there’s a strong collegial atmosphere in the proton therapy realm. Why do you think that is?
SW: I think anytime there is the opportunity to greatly benefit others it tends to bring people together towards that end. When you’re involved in something that can have a positive impact for someone in need, you want to share with others so it can benefit as many people as possible.

Today, the NCI cancer statistics are showing more people are surviving their cancer and living longer. Therefore, they’re experiencing side effects we wouldn’t have seen in the past. We have to look at what technology we have to not only help them survive their cancer, but improve their quality of life. In 2016, there were almost 16 million cancer survivors in the U.S., or about 5 percent of the population, and 67 percent have survived greater than five years, which is where you start seeing side effects. The benefit of proton therapy is that you can’t have a side effect to a site that hasn’t been irradiated. And with cancer survivors projected to increase by 2026 to 20 million, the importance will grow.

HCB News: Last year, there were 26 proton therapy centers treating patients in the U.S. Can you provide the latest numbers?
SW: There are 26 operating full-service proton therapy centers in the U.S. with the opening of the Baptist Health Miami Cancer Institute Proton Therapy Center in the fall of last year. There are three current centers expanding their operations, nine under construction and 15 currently under development.

Of the 26 operating centers, all but three are members of the association with one of the three putting together their application to join the association. We also have developing centers that are members of NAPT, including the MedStar Georgetown University Hospital Proton Therapy Center and the Emory University Proton Therapy Center which both joined last year.

HCB News: Do you have the numbers on how many patients were treated in the U.S. in 2017?
SW: We work with our members to perform an annual survey to track the growth of proton therapy for both indications and volumes. We haven’t started our 2017 survey, but our preliminary data from 2016 suggests approximately 9,000 patients were treated, representing a growth of 15 percent from 2015, which would be the third consecutive year of double-digit growth.

HCB News: How are the efforts to get insurer reimbursement for proton therapy going? Any big breakthroughs over the past year?
SW: We made progress in 2017 with two Medicare administrative contractors covering nine states by broadening Medicare coverage for esophageal cancer, right-sided breast cancer, b-cell lymphomas, Hodgkin’s lymphoma. This is significant for those cancer patients who otherwise would not have been able to receive proton therapy for these indications.

HCB News: Are there certain cancers proton therapy is widely approved for at this point?
SW: The vast majority of cancer indications are widely approved for coverage by Medicare. Commercial insurers still lag behind. For the most part, they cover pediatric, skull-based tumors, ocular melanomas, central nervous system and liver cancers. A smaller portion of commercial insurers cover proton therapy for additional cancers including head and neck cancer.

HCB News: What do you think is the biggest challenge proton therapy currently faces?
SW: The biggest challenge is expanding commercial coverage for more cancer indications. Our members are striving to meet that challenge by continuing to develop the clinical evidence demonstrating the therapeutic benefits of proton therapy. We’re also exploring innovative methods to bring down the costs to provide the service. For instance, by utilizing hypofractionation, it allows clinicians to give higher daily doses and fewer treatments while delivering the same biological equivalent dose. In many instances, hypofractionation can bring the cost down to equal or close to the cost of IMRT. Our members are also analyzing short- term cost benefits as well as the cost savings from preventing long-term side effects such as secondary cancers caused by previous radiation treatments.

HCB News: Is there any notable difference between the average life span of proton therapy equipment compared to other modalities?
SW: Your average linear accelerator is replaced every 10 years. Yet, we have proton therapy equipment that has been treating patients for almost 30 years which is attributable to the extraordinary amount of maintenance that occurs on these machines every night. If you factor in the cost of purchasing three linear accelerators over the same period, the cost of the equipment narrows greatly between the two machines.

HCB News: Have there been any major studies published since our last talk that you'd like to highlight?
SW: Over 100 studies were published last year on proton therapy and there are a few I would like to mention. One abstract highlighted a multi-institutional study that demonstrated patients treated with proton therapy for esophageal cancer had fewer post-operative heart and lung complications than patients treated with other types of radiation.

There were two notable prostate cancer abstracts. One was a follow-up to a previous study that compared outcomes between proton therapy and IMRT. The expanded study analyzed a more contemporary and larger patient population than the previous study. Compared with IMRT, the proton therapy patients had a significantly higher survival rate, fewer bladder complications and fewer secondary cancers.

Another prostate cancer-related study had a direct comparison of clinical outcomes between cohorts of cancer patients treated with IMRT and proton therapy. The investigators from the University of Florida Health Proton Therapy Institute and the Mayo Clinic in Arizona found similar complication rates between IMRT and proton therapy, but significantly higher disease control rates with proton therapy for low- and intermediate-risk prostate cancer patients.

HCB News: With about five months under your belt, how is the association doing?
SW: The association is doing well and growing. Two members treated their first patients in 2017, which is always exciting because it opens new markets to cancer patients that didn’t have access to proton therapy previously. If proton therapy is accessible in cities where cancer patients live, it eliminates the need to travel away from home and/or their family, which is important for them while receiving cancer treatment.

HCB News: What can attendees expect at this month's show?
SW: I think we have a great conference planned which will focus on improving access through education, awareness and outcomes. We’ll be discussing alternative payment models, patient advocacy, legislative efforts, marketing and new technology. If a health system is considering proton therapy, this is the one conference they need to attend.