UW Health plans to offer proton therapy, a form of radiation treatment that more precisely targets tumors for patients with certain cancers, at its planned $438 million, six-story clinic on Madison’s Far East Side.
A groundbreaking for the facility is scheduled for Tuesday.
No Wisconsin site offers proton therapy, which is provided at 36 centers in other states, including Mayo Clinic in Rochester, Minnesota, and Northwestern University near Chicago. On Monday, Froedtert Health together with the Medical College of Wisconsin near Milwaukee also announced plans for proton therapy, with both of the state’s competing academic health centers saying they will start the service in 2024.
Proton therapy is more expensive than regular radiation, which has led critics to question its value. Studies suggest its more precise delivery of radiation is safer, especially for the up to 20% of patients with tumors near sensitive tissue for which proton therapy is typically approved by insurers. Such tumors can be in the prostate, near the eyes, along the spinal cord or beside vital organs like the heart or kidney. Some breast cancers and childhood cancers might also be appropriate, UW Health said.
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UW Health’s $60 million proton therapy project will include new technology by Middleton-based Leo Cancer Care. Patients will sit in a special chair that shifts around a radiation beam instead of lying down while a massive contraption rotates around them on a gantry, as is the case at most proton therapy centers.
Proton therapy “really enables higher precision and less dose to the surrounding, normal structures,” said Dr. Paul Harari, UW’s chair of human oncology. “It’s all about lowering normal tissue side effects.”
Since the Leo Cancer Care model is much smaller than most, the cost is less than a typical proton therapy system, which would have been more than $75 million including installation, Harari said. Leo’s upright approach is more comfortable for patients and can reduce “organ drift” and body movement from breathing, which can present challenges when patients are lying down, he said.
“If the organs move less, you can be more accurate when you’re targeting the radiation,” said Stephen Towe, CEO of Leo Cancer Care.
UW East campus
UW Health’s proton therapy unit, to be on the first floor of its new Eastpark Medical Center, is among many services expected to be available there in specialties such as cardiology, dermatology, ophthalmology and oncology, UW Health CEO Dr. Alan Kaplan told the Wisconsin State Journal last year. Another focus is women’s specialty care.
The project, announced in 2018, was put on hold in 2020 because of the COVID-19 pandemic. The clinic, to include 469,000 square feet of space and a parking structure, is expected to open in 2024. The $438 million price tag, up from an estimate of $348 million early last year, includes equipment and $269 million in construction costs, UW Health spokesperson Sara Benzel said.
UW Health this month announced a campaign to raise $500 million with 100,000 individual donors by the end of 2025.
The clinic will be next to UW Health’s 56-bed East Madison Hospital, which opened in 2015. The campus, in the American Center Business Park east of Interstate 39-90-94 and north of Highway 151, also includes a 50-bed rehabilitation hospital. UW Health might build more facilities on the property in coming years, Kaplan said.
The area is UW Health’s third hub for specialty care in Madison, joining the main UW Hospital complex on the Near West Side and the West Clinic on the Far West Side, Kaplan said.
“By creating more convenient, more coordinated care for people outside the core market, I do believe the regional business would grow,” he said.
Cost concerns
Froedtert Health said it is partnering with Houston-based Legion Health Care Partners to begin construction in early 2023 on a proton therapy unit in its cancer center. The goal “is to increase the availability of precision treatment options and to provide the right care in the right place at the right time,” Tina Curtis, Froedtert’s vice president of cancer services, said in a statement.
Froedtert spokesperson Gerry Steele refused to share a cost estimate for the project, saying its “single vault footprint” will be part of Froedtert’s existing radiation oncology department, “therefore mitigating costs.”
At UW Health, most cancer patients will continue to get regular radiation, which involves photon beams like those used in X-rays, Harari said. Proton therapy delivers high-energy particles that are more likely to stop at the tumor, according to the National Cancer Institute.
Proton therapy costs 20% to 50% more, per treatment, than the most expensive form of regular radiation, Harari said. The ability to deliver higher doses per treatment, because of the improved precision, can sometimes reduce the duration of treatment from six weeks to four weeks, he said.
Harari said Medicare and private insurers typically approve proton therapy for less than 20% of tumors, mainly those abutting critical structures. Of about 180 patients typically receiving radiation treatment at any time at UW Health, roughly 30 might be appropriate for proton therapy, he said.
Since the Mayo and Northwestern proton centers opened several years ago, UW has sent many children who need radiation treatment and a few adults to those centers, Harari said.
Cheryl DeMars, CEO of The Alliance, a Madison-based cooperative of 300 employers that purchase medical services collectively, said she is concerned about the cost of new medical technology because doctors can create demand in health care, unlike most markets.
“That’s a factor that concerns us as we get new technology,” DeMars said. “We’re overpaying for health care services. We need to scrutinize everything to ensure that health care remains affordable, and it’s not right now.”
Dr. Ezekiel Emanuel, co-director of the University of Pennsylvania’s Health Transformation Institute, told Kaiser Health News in 2018 that the financial struggles some proton centers have faced speak to the questionable economics of the technology.
“Something that gets you the same clinical outcomes at a higher price is called inefficient,” said Emanuel, a White House health policy adviser during the Obama administration.
The Boston-based Institute for Clinical and Economic Review, in its 2014 assessment of proton therapy, said that “while data exist to support the use of (proton beam therapy) for a few select cancers, there is inadequate evidence to support its use across a broad range of conditions.”
Wisconsin used to have a “certificate of need” program, which required hospitals to prove the need for major construction projects. The program ended in the 1980s.
In a 2020 study in JAMA Oncology, patients treated with proton therapy were much less likely to have severe side effects than patients treated with traditional radiation therapy, but there was no difference in how long the patients lived.
“Although proton therapy might be a safe option in certain cases when using X-rays is not, it has not been shown to be clearly better than traditional photon therapy in any adult solid cancer,” according to the American Cancer Society.
Among all newly diagnosed cancers in the U.S., proton therapy was used for 1.2% of cases in 2018, up from 0.4% in 2004, according to a study in April in the journal JAMA Network Open.
Leo Cancer Care
Towe, of Leo Cancer Care, said its upright proton therapy model — named Marie, for the late physicist Marie Curie — provides a more natural experience than lying down surrounded by a huge machine. “Patients feel more in control of the situation, more empowered,” he said.
Typical, three-story proton therapy units that rotate around patients weigh 110 tons, while one-story, 1.5-ton Marie rotates the patient instead, he said.
“If you need to change a lightbulb, you don’t hold the lightbulb and rotate the house,” he said. “We rotate the bulb instead.”
Leo Cancer Care, named for the astrological sign that comes after cancer, was started in Australia in 2015. Three years later, it was purchased by Middleton-based Asto CT, co-founded by Thomas “Rock” Mackie, a retired UW-Madison medical physicist who has helped start numerous companies, including TomoTherapy, now part of Accuray.
Mackie is Leo’s board chair. Leo also has an office in England, where Towe is based. The company has about 70 employees, half of whom are in Middleton, Towe said. Last year, Leo announced $25.3 million in Series B fundraising.
With technology involving a Wisconsin Alumni Research Foundation patent and investment from WARF, Leo has also developed upright systems for regular radiation treatment and imaging. Towe said those markets are much larger than proton therapy.
Fave 5: Reporter David Wahlberg picks his top stories of 2021
COVID-19 dominated my year again as the State Journal’s health reporter, except for June and July, when it seemed we might overcome it. Vaccinations and variants were new angles this year. I also covered continuing deaths from the pandemic and challenges for health care workers.
During the summer dip in coronavirus activity, I wrote about a little-known hereditary disorder tied to several cancers, for which Fitchburg-based Promega Corp. has developed related testing.
This fall, I spent much of my time working on a three-day series about newborn screening, focusing on how the testing varies among states. If you were born since the mid-1960s or had a child since then, you’ve almost certainly taken part in this screening, which looks for rare diseases for which prompt treatment can prevent death or disability.
I love transplant stories. Dr. Matt Wolff had quite a backstory to his heart-kidney transplant.
In February, I wrote six more vignettes about people who died from COVID-19.
Little-known Lynch syndrome is more common than BRCA mutations for breast cancer.
In September, I visited the COVID-19 unit at St. Mary's. These dedicated workers are tired.
I spent much of the fall looking into the unequal practice of newborn screening among states.