MacDonald says Florida is also closing that gap. Southwest Florida Proton in Estero delivered its first treatment on December 30, 2025, becoming the first proton center on Florida’s west coast. The facility started with prostate cancer but quickly expanded to pediatric tumors, brain and skull base tumors, breast cancers, and head and neck cancers. Physicians across the region and beyond are now referring patients with a wide range of cancers, MacDonald says.

It’s welcome news for Florida patients, she says, but much of the U.S. remains a proton therapy treatment desert; particularly the West Coast, where the nearest center can be hours or even states away. “No one in this country should have to relocate for a month or two to access a treatment that could improve their outcomes,” she maintains.


To Durkee, the situation is more nuanced. Access to care is a nationwide challenge, he says, and getting top treatment often requires travel. “Proton therapy is no different.”

Still, cost and insurance coverage remain the biggest barriers, even as momentum builds.

Building the case
MacDonald says proton therapy’s reimbursement woes are easing as evidence shows it can reduce treatment complications. Once lacking in scientific evidence, the therapy is now supported for select patient populations, prompting a shift among insurers. “In recent years, more insurers have come to realize that proton therapy is indeed a treatment with the best outcomes for many patients.”

“Yes, it costs more than traditional radiation therapy,” MacDonald concedes. “But for certain patients, proton therapy provides superior results with fewer side effects and better long-term results.”

Better long-term outcomes for patients, yes, but not always for the finances of proton centers, Durkee adds. “On the business side, it’s not a clear money-winner. Some institutions end up in Chapter 11 despite various financing arrangements.” He urges facilities to assess how proton therapy fits into their overall strategy before investing.

UW, for its part, is testing a hybrid approach: one accelerator powers both a traditional gantry and the upright Marie by Leo Cancer Care, letting clinicians compare efficiency, patient comfort, and dosimetry. Like Stanford, the upright system treats patients in a movable chair, Durkee says, which could improve comfort, better align certain organs, and lower costs. The first patients are expected this spring.

“When we go to meetings nationally and internationally, people want to know which approach to invest in,” Durkee says. “We’ll be the only center in the world with both in-house, and we’ll be able to compare them head-to-head.”

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