The National Association for Proton Therapy (NAPT) is getting ready for its annual National Proton Conference, taking place May 6 through 9 in Salt Lake City. In preparation for the event, HealthCare Business News sat down with Jennifer Maggiore, the organization’s executive director, as well as Dr. Elizabeth Nichols, a board-certified radiation oncologist at the Maryland Proton Treatment Center.
HCB News: Can you tell us about your background with proton therapy and the NAPT?
I worked for many years at an outpatient cancer center that incorporated proton therapy into their cancer program in 2015. I managed their patient services department. I have always been passionate about supporting patients as they navigated through their cancer journey. A cancer diagnosis is overwhelming, and it is vital to provide support and resources to cancer patients and their caregivers. I joined the NAPT Board in 2017 to support their mission to increase patient access to proton therapy. I become the Executive Director in 2019 and was privileged to be trusted by the Board of Advisors and member centers as the community navigated the early days of the pandemic and initiated crucial advocacy efforts surrounding reimbursement.
Dr. Elizabeth Nichols:
I am a board-certified radiation oncologist and have been in practice for 10 years with the University of Maryland Department of Radiation Oncology located in Baltimore. I helped design and open our proton center, the Maryland Proton Treatment Center and have been practicing there since we opened in 2016. My clinical and research efforts focus on women's cancers (breast and gyn). I have a passion for the use of proton therapy in these diseases especially for the treatment of young women. I love being an oncologist and being able to offer patients state of the art therapy that not only can cure their cancer but also give the least long term side effects possible!
Our proton center has been a long-time member of NAPT. I have recently become a Board member which I am very excited about. I hope to continue to advocate for the use of proton therapy in patients with cancer and contribute to the growing literature that shows the benefits of proton therapy. I also want to continue to improve equitable access to this type of therapy for all patients.
HCB News: Looking back over the previous couple years, what have been some of the industry milestones for proton therapy?
In recent years, there has been a significant increase in cancer centers that offer proton therapy in the US and around the world, increasing the number of patients that can benefit from this treatment.
There have also been advances in technology that make it more accessible and affordable for health systems to incorporate into their cancer programs. This is a critical advancement as we strive to ensure the treatment is available to patients who need it the most.
Another key milestone is the growing body of clinical evidence demonstrating the efficacy and value of proton therapy for a variety of cancer types. As more leading academic centers including NCCN and NCI designated comprehensive cancer centers adapt this technology, the research supporting its value becomes more robust.
There has also been an increase in collaborations and partnerships between proton therapy centers and other healthcare providers, which has helped develop and refine proton therapy techniques and protocols.
In the meantime, there has been a growing awareness of proton therapy among patients and the general public, which has helped increase access to this treatment option and improve patient outcomes.
The last couple of years have been an exciting time in proton therapy as we have activated and treated many patients on clinical trials aimed to help prove the role and benefit of proton therapy. We have had data come out supporting the use of proton therapy in oropharynx cancers as well as esophageal cancers to start with a view and the newer cancer guidelines continue to expand the recommendations for proton therapy.
From a technology viewpoint, we are now able to offer the same image guidance as we do in photon therapy and there is on-going research to develop proton arc therapy as well as other techniques to treat our patients.
On a research front, there continues to be exciting work looking at the use of FLASH radiotherapy with a recent clinical trial completed delivering this therapy to patients with bone metastasis.
Lastly, as more proton therapy centers have opened, we've really been able to expand the access of this technology to more and more patients although there is still more work to be done. Thankfully, groups like NAPT have made this mission a priority.
HCB News: What's been happening with reimbursement?
NAPT continues to engage with CMS and CMMI to ensure payers understand the value of proton therapy. It has been a challenge for payment models, such as the RO model, to adequately recognize the short- and long-term cost savings of advanced radiotherapy techniques. Commercial payers who acknowledge recent clinical research supporting the benefits of proton therapy are including this technology as a covered benefit for certain tumors. Unfortunately, radiation oncology overall has experienced a steady decline in reimbursement over the past decade. But the main driver of cancer care costs is hospitalizations and chemotherapy in the last few months of life, not advances in radiation oncology A study published in JAMA Oncology in 2019 showed that when combined with chemotherapy, proton therapy reduced the incidence of adverse side effects such as hospitalizations. Although proton therapy has higher upfront costs, reducing toxicity of treatments can reduce costly short and long term side effects and allow patients to return to a productive life.. NAPT will continue to advocate for fair and stable reimbursement.
HCB News: What advice do you have for providers who want to refer patients for protons, but aren't sure where to begin?
The NAPT website has a map that lists U.S. proton therapy centers and includes contact information. We also have a list of resources to help with lodging and transportation for patients who need to travel to receive care. Our member centers also work directly with patients to reduce barriers and guide patients through the referral, insurance, and treatment process.
For providers who want to refer patients for proton therapy but aren't sure where to start, I first recommend researching where the nearest proton center is located. If you are unsure, you can access the NAPT website which has numerous great resources. For those who have access to a local proton center, I recommend contacting the center for patient referral. Most proton centers have a streamlined, patient friendly intake process. In the scenario where a patient may need to travel out of state, most proton centers will offer a review of the clinical details prior to seeing the patient (and subsequent travel) to ensure proton therapy eligibility. While many providers work with a great local radiation oncology team, sometimes there may be provider and/or patient hesitancy to refer to proton therapy and seeking a second opinion may be considered.
HCB News: Are you seeing more multi-gantry facilities ramping up, or more single-gantry?
Most new centers in development are multi-modality treatment centers with a single room solution. Many are collaborations with an academic center or larger health system. A great example is Penn Medicine that recently supported two community centers, one in Virtua and one in Lancaster. There is a commitment to bring this technology to the community and increase access for patients.
HCB News: What are some of the key initiatives that the NAPT is currently focusing on?
We are committed to increasing patient access to proton therapy. We are focused on:
1. Ensuring payers understand the value of proton therapy
2. Supporting multi-institutional research that provides evidence to support the use of proton therapy for patients who would benefit from the advanced technology
3. Supporting current members and nurturing the development of future centers
4. Increasing public awareness of the value of proton therapy
HCB News: Can you tell us a bit about what attendees can expect at this year's meeting?
This year’s conference, to be held in picturesque Salt Lake City, is packed with over 25 sessions, multiple networking events, and an opportunity to tour one of NAPT’s Member Centers. We will be welcoming Amy Bassano, formerly with CMMI, as she discusses the future of value-based care. We will have a dedicated panel of experts to provide an update on the future of FLASH and modern technology offerings to the community. We are also featuring a special clinical session on hypofractionation in partnership with PTCOG-NA. NAPT has curated panel discussions and other sessions with multi-institutional representation to provide real takeaways and solutions regarding staffing challenges and reducing barriers to insurance denials and delays.
HCB News: Are there any sessions or presentations that you're particularly excited about?
In what is becoming an attendee favorite, the session "Navigating the Journey Together: Insights from a Patient Panel” is a unique and compelling presentation that one should not miss at the 2023 National Proton Conference. The session will feature a panel of patients who have undergone proton therapy and will share their experiences, challenges, and insights on their journey. This is a fantastic opportunity to learn from real-life patients and understand their perspectives on how proton therapy has impacted their lives.
At the same time, this session will provide valuable insights for healthcare providers, administrative teams, and industry experts, enabling them to gain a better understanding of the patient experience, improve the quality of care, and identify areas for innovation and improvement.
I am very excited about the PTCOG-NA special session on hypofractionation. There has been some hesitancy in the field to utilize hypofractionation especially with proton therapy due to concerns of potential skin toxicities depending on the type of cancer being treated. I am interested to see the work on disparities and proton therapy, and I am also excited to hear about the new and exciting things happening at other proton centers. The meeting is a great time to network and collaborate on ideas.