HAMPTON, Va. – When several Hampton University alumni asked Hampton President William Harvey whether he was familiar with proton therapy for cancer patients, the veteran university chief said “no,” then took the alums’ friendly challenge to explore the topic. His initial readings sparked his interest.
Within a few months, Dr. Harvey was assigning widely respected Hampton nuclear physicist Dr. Cynthia Keppel to do more exploration. Soon, Harvey was more than up to speed. He had concluded his school should embrace proton therapy and began selling his board of trustees, then the lending community, on his ambitious idea of establishing a proton therapy treatment center at Hampton.
Today, the new $225 million Hampton University Proton Therapy Institute, one of eight therapy sites in the United States and the only one in the region, is open for business.
In operation for more than a year, the two-story, 98,000-square-foot facility is filled with state-of-the-art equipment and a professional staff of oncologists, nuclear physicists and engineers—some distinguished veterans and some ambitious rookies—recruited from around the country for their expertise and interest in proton therapy.
Working as a team, they have been helping cancer patients learn whether they (cancer patients) can employ proton therapy as an alternative to traditional therapeutic radiation and chemotherapy treatments in fighting the life-threatening disease. It focuses on treating adults with prostate, breast, lung and eye cancers and children with cancer.
“We dream no small dreams,” says Harvey, asserting that having such a major health care facility at a small college, particularly a historically Black college, marks a huge step for his and similar institutions. He says investing in the facility puts Hampton into the fight against cancer and asserts that the proton therapy facility will enhance the university’s educational programs in the sciences, support the city’s economy and provide a needed medical service to area citizens.
In exploring proton therapy early in the last decade, Hampton officials found more than a few reasons for getting more involved in the fight against cancer, including what they consider a high rate of deaths from colon cancer in nearby Chesapeake, Va., and a high number of deaths from prostate cancer in the Hampton Roads area. Asbestos was used heavily at the nearby Newport News shipyards, officials at the proton center note, but they say it is impossible to pinpoint precisely the source of these episodes of cancer.
The Hampton Roads area, of which Hampton is a part, leads the nation in prostate cancer deaths. Hampton already had a medical physics program (the only one at an HBCU) and a working relationship with the nearby Thomas Jefferson National Accelerator Facility, a federal nuclear research facility. Keppel, director of Hampton’s Center for Advanced Medical Instrumentation, was a staff scientist at the Jefferson facility. The need and ability to respond was here, the school found.
Nationwide, Black men have a nearly 60 percent higher rate of prostate cancer than Whites, a fact Harvey said helped drive the message home that, if his school could do something to address this killer, it should. He could make a case for the investment paying for itself with quality care from respected professionals, and, for sure, there was a need in the area for the services he was proposing.
“In Brewton (his tiny hometown in Alabama) my folks told me not to curse the darkness but to light a candle,” says Harvey. “That’s what I’ve tried to do.”
Proton therapy is considered the most precise and least life-disruptive form of cancer treatment among the variety of options available to many people diagnosed with cancer, as proton therapy directs radiation beams precisely at the diseased tissues to destroy them.
Compared to other forms of therapy like radiation, which is often paired with chemotherapy, proton therapy does less damage to nearby healthy body tissue, since proton beams hit their target and basically stop penetrating the body while radiation continues to penetrate through the body beyond its target.
Depending on the severity of the cancer being treated, radiation treatments can be quite painful, can damage the body’s immune system over time and slow or sideline a cancer victim. Proton therapy, although a form of radiation, appears to have fewer side effects.
Patients must undergo 44 days of proton therapy—which is not administered during weekends—making it as costly as the more widely used forms of treatment, Hampton officials acknowledge. Plus, there are the added costs of staying in a city where the treatments are offered. While most patients to date have come from the Hampton area, some patients have come from as far as Qatar.
The up-front costs for the provider are also steep, they note, and this discourages many schools from making an investment in such a center.
The therapy professionals who run the facility say the investment is worth it for patients and the school and add it’s worth it for patients, especially children, who are facing months or years of quality-of-life questions. It’s also worth it for the provider, in this case Hampton, as there will be the need for cancer treatment for the foreseeable future and therefore a revenue stream to recover the investment made in the facility.
At present, most patients seen at the Proton Therapy Institute are adults. By the time it is running at full speed (the goal is sometime next year), it hopes children seeking proton therapy will make up 15 to 20 percent of its patient population.
“It’s important to have a choice,” adds Dr. Christopher Sinesi, a leading Virginia oncologist recruited in 2006 by Keppel to be medical director of the institute. “The bottom line is quality of care,” Sinesi says, noting that many cancer patients who might qualify for proton therapy simply don’t pursue it due to the costs of being away from home and getting treatments.
Sinesi acknowledges that proton therapy is expensive, quickly adding that “cancer treatment is expensive.”
A physician for more than 20 years, Sinesi says the costs of proton therapy compared to other forms of treatment could be about the same over time, however. He says proton therapy requires fewer return visits for follow-up treatments than other forms of therapy and less costs for personal health care stemming from the side effects of radiation and chemotherapy treatments.
Veteran oncologist Dr. Allan Thornton, recruited by Hampton from the Indiana University Health Proton Therapy Center, echoes Sinesi. He acknowledges that proton therapy has its skeptics in the medical community. Still, having worked with proton therapy for more than a decade, he’s a believer.
“Until referring physicians understand the wide range of benefits of proton therapy, there is going to be a wide range of reticence,” says Thornton. To spread the word about proton therapy as a possible treatment option, Thornton says the institute is holding seminars and public forums and issuing news releases to referring physicians about proton therapy.
After a 2007 groundbreaking for the new facility, located in a quiet office park about 10 minutes from the Hampton campus, Hampton launched its construction program during what was evolving into the nation’s worst economic slump since the Great Depression. Still, the school was able to secure and hold on to some $200 million in construction loans at favorable rates from three principal backers: SunTrust Bank, PNC Bank and J. P. Morgan Chase.
The city donated five acres of land on which the new institute was built. Sentara Healthcare, based in nearby Norfolk, provided some financial backing. To round out its financing, the school secured a $15 million federal grant and a $2 million grant from the state of Virginia.
Hampton also worked a deal for the school to acquire another nearby five and a half acres of city-owned land in a land swap.
Hampton gave the city 18 acres of land in exchange for the city’s parcel plus $1 million. Hampton plans to build a hotel on the extra site to accommodate therapy center guests.
Built as an outpatient facility that could eventually treat some 170 patients a day, Hampton’s Proton Therapy Institute appears to have an array of state-of-the-art essentials to provide care aimed at reflecting sensitivity to the patient and his needs.
There is a receiving area and nurse’s station. There is a fabrication room where patients can be measured for customized body wear used to keep them still during treatments. The facility’s CT scanner has the largest bore (the doughnut-shaped hole in which a person’s body and the treatment items go for visual imaging of the cancerous tissues) available, says Dr. Srividya Duvvuri, the medical physicist who ensures that the equipment used at the institute does what it was designed to do.
The therapy institute includes five treatment rooms. Four are three-story-high rooms each equipped with an ISA Gantry, a stationary frame with a movable doughnut-shaped wheel inside to which the proton beam nozzle is attached. The wheel can circle a patient at 360 degrees while the patient rests on a robotic treatment bed. That combination of equipment flexibility helps ensure precise targeting of the proton nozzle beam before radiation is released, says Duvvuri.
Big Gamble Pays Dividends
To offset the sterile office park look, Hampton’s therapy institute building has two floral gardens suggested by Hampton first lady Norma Harvey. In one garden is a small tree that was a section of the university’s historic Emancipating Oak, a tree under which it is said President Lincoln’s Emancipation Proclamation ending slavery was read.
Hampton’s big gamble is already paying dividends, at least for cancer patients who opted to give proton therapy a try.
“The drive was worse than the treatment,” joked 30-year-old Brannon Thomas, a women’s soccer coach at the College of William and Mary, referring to his drive through “the tunnel” from his home in Virginia Beach to the therapy center.
Thomas, who was diagnosed with brain cancer in 2003 at age 21, says subsequent brain surgery removed 70 percent of his cancerous tumor. To minimize damage to the healthy brain tissue surrounding the remaining cancer, he and his doctors decided to pursue proton therapy.
“I feel good,” says Thomas, who had planned to study medicine in college and had concerns that traditional radiation therapy might harm his healthy brain tissues and cause him more harm over time.
“There are some residual effects with the treatment, which is to be expected,” Thomas says, adding, “I am cancer free. I don’t come back with any reservations.”
Lankford Blair, a 62-year-old health counselor diagnosed with prostate cancer in 2009, shares a similar sentiment. He says his doctors detected no material change in his PSA count (the chemical measure of the level of prostate-specific antigen, or protein, in a person’s blood) and decided there was no urgent need for him to begin treatment, knowing the Hampton facility was opening soon.
The higher a man’s PSA level, the greater the likelihood he has cancer. Today, 60 percent of the therapy center’s patients are being treated for prostate cancer.
“We could have gone with other options, but decided to wait until other things opened up,” Blair says. “We knew this was cutting edge. For me, it became a no-brainer.”
Blair, who has completed his treatments, says he has had fewer side effects than he feels would have been the case with traditional radiation treatments.
Blair says his primary care doctor was not aware of Hampton’s new venture and says a person’s doctor may not know everything available. “They’re only going to tell you what they know,” Blair says. “So, it’s important t
o do your own research.”
Harvey says he sees his school’s new venture playing a role in “easing human misery and
saving lives.” In the process, he adds, “It shows a small Black school can do something huge. We hope it will be an incentive for other small institutions, Black institutions, to say ‘Yes, I can’ as well.”
Hampton’s Case for Proton Therapy
• Using properties of the proton beam allow the beam to be configured to the exact dimension of the diseased tissue and penetrate deeply like standard radiation. However, with proton therapy, the physician would expect
little or no side effects because of less energy being deposited and, consequently, less damage to normal neighboring tissues.
• Tumors growing near sensitive normal tissue will show the greatest advantage from proton treatme
nt. This will include tumors close to or involving the spinal cord, kidney, liver and prostate. Many intracranial tumors including pituitary lesions fall into this category. Tumors isolated at the back of the eye also can be treated with proton therapy as protons improve the chances for preservation of sight.
• Pediatric cancer is a special category of disease that merits special consideration for proton treatment bec
ause reducing damage to normal tissues reduces side effects and reduces the likelihood of growth and developmental ab
normalities that might accompany treatment with standard
• Prostate cancer is a challenging disease because of its prevalence and its location between two particularly radiosensitive areas — the bladder and the rectum. Protons can be used to bring the dose of radiation to the prostate up to the high levels needed for tumor control while sparing the bladder and rectum.
This reduces the risk of the short-term, but often severe, side effects of urinary frequency, rectal irritation/bleeding and sexual dysfunction, as well as the long-term risk of permanent damage necessitating colostomy.
SOURCE: HAMPTON UNIVERSITY PROTON THERAPY INSTITUTE