Two years ago, in September 2010, the Hampton University Proton Therapy Institute treated its first patient for prostate cancer. After years of planning and seed money from local, state and federal sources, HUPTI, a $225 million project — the brainchild of Hampton University President William Harvey — emerged as the largest freestanding facility of its kind in the world and only the eighth such treatment center in the United States.
Harvey predicted the institute would treat more than 2,000 cancer patients a year, generate close to $50 million in annual revenue, and contribute millions in taxes and spinoff spending annually to the local economy, while "saving lives and easing human misery." He particularly emphasized HUPTI's importance for the treatment of prostate cancer in Virginia's African-American community, which has one of the highest rates – 233 per 100,000 — in the country, according to the Centers for Disease Control.
Now starting its third year as a treatment facility, HUPTI has encountered some roadblocks — from studies questioning whether proton beam therapy is the best treatment for prostate cancer to delays in the delivery of its specialized equipment.
Undeterred, Harvey said, "We haven't changed the plan — the actuals have changed. … I think our center's doing pretty well."
Proton therapy use
Prostate cancer is the most widely diagnosed cancer in U.S. men, affecting more than 240,000 in 2011, according to the American Cancer Society. When HUPTI opened, proton therapy was touted as the best treatment for its highly targeted radiation beam that spares surrounding healthy tissue and minimizes associated side effects, such as rectal bleeding. Now, its supremacy has been disputed by some, including a 2012 University of North Carolina-Chapel Hill study, and there are no definitive or conclusive clinical studies to counter it.
Leonard Arzt, executive director of the National Association for Proton Therapy, dismisses the UNC "observational study" as flawed on several counts and is anticipating that a multi-year federally funded Massachusetts study will yield a clearer picture.
However, Robert Foote, chair of the Mayo Clinic Rochester, which is building a proton therapy center set to open in 2015, said, "There are some medical conditions where proton therapy has proven to be the superior treatment and others that require more research — prostate cancer is one of those conditions."
HUPTI radiation oncologist Allan Thornton, however, has no doubts.
"I would challenge any radiation oncologist with an opportunity for proton therapy, not to use it," he said. Harvey concurs, "It's absolutely the best thing. Hopefully we'll be able to do our own clinical studies. We're approaching 400 patients. We're getting a body of knowledge."
Increasingly — and without controversy — proton beam therapy is being employed to treat other localized cancers, such as eye, neck, brain, breast, lung and pediatric cases.
"Look at the ones that want it; we're in pretty good company," said Harvey, noting the number and quality of hospital systems planning or building their own proton therapy centers, including Georgetown University, Memorial Sloan-Kettering Cancer Center and Johns Hopkins. "There's been some negative publicity. We don't think it's accurate at all..."
Before HUPTI's 98,000-square-foot center opened, officials projected the treatment of 2,000 patients annually, with the institute's five treatment rooms able to accommodate 125 patients a day.
After opening in late summer 2010, it treated 85 patients that year and saw nine of them through the complete treatment process, according to figures supplied by the institute. A typical treatment spans 39 days in brief 15-minute sessions — the radiation itself takes about 60 seconds — delivered on successive days.
In 2011, the center's first full year of operation, it treated 230 patients with 151 completing treatment that year. (With the length of treatments, some start one year and end the next.) This year, it has completed treatment for 216 through August, according to Edward Dickey, chief of clinical services. In all, it has seen nine pediatric patients, but their numbers are expected to increase dramatically now that — after a six-month delay — the institute has finalized arrangements for pediatric sedation with Children's Hospital of the King's Daughters in Norfolk. Its first patient, a 23-month-old, is scheduled for Sept.10.
Harvey maintains that the institute is on track, working in a single shift — many proton centers operate a double shift and some around the clock — to treat 1,500 patients annually by 2014 and to meet the original projection of 2,000 by 2018. He attributes the slow start to a delay of more than a year in the delivery of the highly specialized proton equipment by Belgian manufacturer IBA, which, he said, also affected the new centers at the University of Florida, Mass General and Penn Medicine's Roberts center. Four of HUPTI's treatment rooms are now open, and the fifth finally received the necessary equipment in June.
Before the center opened, Harvey indicated that about two-thirds of treatments would be for prostate cancer with a focus on the local African-American community. In August, Harvey confirmed those figures, and expects them to remain steady; however, HUPTI said it does not track patient statistics by gender or race and has declined to share statistics on the types of cancer it has treated to date.
Whence its patients
Initially, there was talk of building a hotel on the premises to accommodate patients visiting from out of town. Back in 2010, Harvey projected a potential boost to the local economy of between $10 and $20 million generated by incoming patients and their families, estimating that 60 percent would be traveling. However, HUPTI records show nearly three in four patients are from Virginia, a percentage that has held steady since the cancer-treatment institute opened. Others hail from more than two dozen states, with North Carolina sending the highest number of out-of-state patients. The institute has also registered one patient each from Argentina, the U.S. Virgin Islands, Canada and England.
Harvey characterizes it as "a chicken-and-egg" scenario. "The hotel is still on the drawing board. If we ramp up, we'll need it," he said.
Earlier this year, HUPTI treated its first patient from Saudi Arabia. Radiation oncologist Thornton was instrumental in setting up a partnership with SAH Global in the Middle East to bring patients to Hampton until a proton therapy center is built in that region. Thornton is consulting on proposed centers in Qatar and in Manchester, England.
The center has not released revenue figures, but Harvey told BusinessWeek this spring that the center's annual revenue might hit $47.5 million by 2014. That's comparable to the $45.5 million in patient care revenue reported in 2009 by the University of Florida's proton therapy institute, according to a March 2012 Bloomberg News article.
The $225 million HUPTI was built on 5.5 acres of land donated by the city of Hampton, which also provided $1.3 million for staffing.
"The city has been really great," said Harvey, while expressing disappointment with the state's contribution. This year, the Virginia legislature approved $510,000, a drop from the more than $2 million it accorded in 2011, but the same as it gave in each of the two preceding years.
"It's the only state that has not provided support to the tune of $10 million. We'll continue to do good work. Perhaps the legislators will become enlightened," he said. The institute was funded partly by $21.4 million in federal and state money, according to information it provided. The remainder came from donations, private loans and tax-exempt bonds.
"Things are going pretty well for us. We're a little ahead of the mark on bonded indebtedness," said Harvey.
The institute has attracted $14 million in federal research contracts for prostate and breast cancers from the Navy over six years, and a one-time $1.3 million grant from the Army in 2009. Harvey emphasizes, however, that HUPTI is a treatment facility and that research is a small part of its work.
In the future
"The challenge is being a stand-alone facility," said Keith Gregory, hired as HUPTI deputy executive director this summer. "We're one of the few not affiliated with a health system directly or indirectly. We have to depend on patients to refer themselves, to look at us on their own."
Hampton is not alone in this. Nationally, 70 percent of proton therapy patients are self-referred, according to Harvey, who has been frustrated by the lack of support from the medical community.
"If we've got a reputation in Hampton Roads as a place to get good cancer care — whether with protons or photons — it's not a competition, but a complement," he said. He has not ruled out a partnership with a health system, acknowledging that the only inquiries have been from outside the region.
For now, the current focus is to solidify the procedures in place for existing patients and to make the technology more available to others, said Gregory.
What is proton therapy?
Proton therapy uses a 200-ton cyclotron to spin subatomic particles to two-thirds the speed of light to create a proton beam that targets tumors with millimeter precision. It is one of a variety of radiation therapies now available for the treatment of localized cancers, including prostate, lung, breast, eye, brain and pediatric.
Though significantly more expensive than other radiation therapies, such as conventional and IMRT (intensity modulated radiation therapy), proton therapy is routinely covered by Medicare and Medicaid. Most other insurances cover it, but some do so only on a case-by-case basis.
The Senior Center of York is hosting a talk, "Proton Therapy Cancer Treatment," Wednesday, Sept. 26 at 12:45 p.m. To register, call 757-898-3807 by Sept. 24.Copyright © 2015, CT Now