Extending the reach of proton therapy

By Kirsten Weir 

Photos by Peggy Peterson 

When the Roberts Proton Therapy Center opened at Penn Medicine’s Abramson Cancer Center in 2010, patients came from far and wide to access the pioneering cancer treatment. Now, the largest and most advanced center in the world for proton beam radiation is applying its expertise to communities beyond Philadelphia. This expanded reach is part of Penn Medicine’s unique “hub-and-spoke” model to open the door for patients to receive world-class cancer care closer to their homes.

In late 2022, Penn Medicine Lancaster General Health’s Ann B. Barshinger Cancer Institute opened the only proton center in central Pennsylvania. The following spring, Penn Medicine partnered with Virtua Health to open southern New Jersey’s first proton therapy center on the Virtua Voorhees Hospital campus. “The hub-and-spoke model for proton therapy doesn’t exist anywhere else,” said Jeffrey Bradley, MD, vice chair of Proton Therapy & Technology Development at Penn Medicine. “Proton therapy provides advantages for many people with cancer, and increasing access to people in their communities makes a big difference to the populations we serve.” 

For the right patients, proton therapy offers significant benefits, including better sparing of healthy tissue and lower radiation toxicity. Until recently, patients in central Pennsylvania and southern New Jersey had to travel to Philadelphia to receive the treatment—a significant burden, since proton therapy is typically administered daily for six to eight weeks. 

“Many patients came to the Roberts Center from very far away, yet we were still seeing only a small sliver of the patients who would be candidates for proton therapy,” said Graeme Williams, MD, MBA, a Penn Medicine radiation oncologist who trained at the Philadelphia facility before being hired to build out the proton therapy program Penn now runs in partnership with Virtua Health. “This hub-and-spoke model is an innovative investment in a treatment that is still only available at a limited number of places across the country.” 

The gift of time for patients receiving treatment near home 

Penn Medicine’s investment in region-wide access to proton therapy made all the difference to Lindsay Schoenberger of Lancaster, who was diagnosed with stage four glioblastoma at age 36. After surgery to remove the tumor, she began chemotherapy and six weeks of daily proton therapy. If she’d been treated at the Roberts Proton Center, she said, her mom would have had to take time off work to care for her in temporary housing in Philadelphia. And Schoenberger would have had to scramble to find someone to watch her dog Ruby and ferret Booker. “It would have disrupted our lives,” she said. Instead, she had proton therapy in Lancaster, close to her home and her support network. “I was so grateful to get the treatment just 10 minutes from my house. Everyone at the radiation center was so friendly, and seeing their familiar faces each day made the treatment easier,” she said. 

Schoenberger’s experience is a familiar one to Randall Oyer, MD, executive medical director of the Ann B. Barshinger Cancer Institute. “One of the things that is so important to cancer patients is time. The time saved by being treated close to home has really been a gift to patients and their families,” he said. “They tell us that because proton therapy is located locally, they can take less time off work or take their children to school. They have more time for the things that matter most to them.”  

Centralized expertise, available in more places 

Proton therapy requires a significant financial investment, since proton accelerators are expensive to install and maintain. But cost is just one limitation. “There’s a big learning curve for providers to become proficient with the therapy,” said James Metz, MD, chair of Radiation Oncology. In Penn Medicine’s model, physicists and dosimetrists at the Roberts Proton Therapy Center develop individualized plans for each patient. Those plans are sent to community centers in Lancaster and at Virtua in New Jersey, where local oncologists administer the treatments to patients.

“By centralizing the planning process and standardizing care across all our facilities, we’ve been able to open new centers that offer the highest standard of care from day one,” Metz said. “This model allows us to make sure all of our treatment teams have access to all the tools in the toolbox, so they can determine which therapies are right for individual patients.” 

Thanks to Penn Medicine’s long history with proton therapy, staff have expertise in practical aspects of insurance and billing as well. Because proton therapy is less established than conventional radiation, insurance companies have more restrictions on what it can be used for. Part of the success of the hub-and-spoke model stems from Penn Medicine’s expertise in advocating for patients who would benefit from the treatment. 

The Abramson Cancer Center has thought carefully about how to distribute many kinds of specialized services across the region, Metz added. Within radiation oncology, treatments including brachytherapy, stereotactic radiation, and proton therapy are all offered at select community cancer centers. “By offering those services at some but not all locations, we can provide regional access while making sure we maintain enough patient volume so that providers can stay highly proficient,” Metz said. 

The success of Penn Medicine’s regional care model also owes its success to the quality of its training programs, said Pamela Boimel, MD, PhD, medical director of Radiation Oncology and director of Proton Therapy at Penn Medicine Lancaster General Health, who, like Graeme Williams, trained as a resident in Radiation Oncology at Penn in Philadelphia. “Penn Medicine has worked hard to develop a global education platform that prepares physicians to provide proton therapy, both across our system and around the world,” she said. 

As research continues to propel proton therapy forward, patients at Lancaster and Virtua are poised to reap even further benefits, she added. “As we learn more from clinical trials, we can roll out what we’ve learned to community cancer centers—and potentially even offer the opportunity to participate in trials to patients at our community sites. That really speaks to Penn’s mission of providing equitable care,” she said. 

Ultimately, Penn Medicine’s commitment to establishing a cohesive system of advanced care across its facilities will serve as a model for other health systems to follow, Oyer predicts. “Penn is the only system so far that has put proton therapy into community sites while maintaining centralized protocols, safety, and standards of care,” he said. “It is an extraordinary gift that I believe will transform the way cancer care is provided across the country.” 

The power of protons: related stories 

The power of protons: Penn Medicine has treated more than 10,000 cancer patients with proton therapy—while leading the way in research on the healing potential of these positive particles.

Patient-powered proton study looks at long-term side effects: The RadComp study asks, could proton therapy reduce some long-term side effects while maintaining comparable cure rates to traditional radiation? 

FLASH forward to an ultra-fast new form of radiation: An experimental method delivering proton therapy radiation in just a few doses lasting mere seconds each, could be a paradigm shift in radiation therapy.