Red Journal shines beam on protons: Part 1


The prestigious International Journal of Radiation Oncology-Biology-Physics, or Red Journal, has devoted an entire issue to the subject of particle therapy—bringing protons into the limelight of medical practice. It is the official journal of the American Society for Radiation Oncology.

Much of the nearly 600-page issue, nearly double the normal size, includes 75 articles ranging from clinical outcomes to commentary on a modality increasingly gaining recognition as a preferred option for treatment of tumors. (more…)

Patient waits it out for proton therapy


When Jacques René Sirois was diagnosed with prostate cancer back in 2014, he knew what he wanted, and he didn’t mind waiting for it.

“I’m not a surgery type of person,” says Sirois, of Franklin, Tenn. For good reason. His brother, diagnosed at 56 with prostate cancer, had undergone a prostatectomy.

“He had surgery—I remember the pain he went through. He’s still suffering the effects at 64,” he says. “Another gentleman I know had radiation. He’s a total mess now.”

Then he met someone who had received proton therapy at the U.S.’s first treatment center in Loma Linda, Calif., and Sirois began looking into the option.

At his doctor’s office, the nurse practitioner offered a range of treatment alternatives, but proton therapy wasn’t on the list. His doctor mentioned it dismissively, because there is no treatment center there.

But Sirois had already found Provision Center for Proton Therapy himself, met with Dr. Marcio Fagundes and made his decision.

“After the consult I said, ‘I know what it’s going to be,’” Sirois says.

His insurance, Cigna, disagreed, denying coverage for proton therapy. He was 64. So Sirois decided to wait for Medicare, taking hormone therapy in hopes of keeping the cancer at bay until then. The plan worked. His PSA level went down, and he was able to wait until insurance kicked in, and he could travel to Knoxville.

But he didn’t wait to spread the good word about proton therapy. Sirois says two patients have come to Provision for cancer treatment on his recommendation, while another sought proton therapy treatment at a different center. And when he finally was able do the treatment himself, all lived up to his expectations.

He traveled from Franklin, a town just outside of Nashville, each week alone for treatment. But at Provision, he says, gesturing toward the lobby, “you’re not going to sit here by yourself.” He’s found the same level of hospitality among the Provision staff, which has made the stretches he’s away from home a little easier, he says.

“I am just amazed at the bedside manners,” Sirois says. “It’s from the minute I walk in to the minute I walk out.”

His friends at home didn’t forget him, though. They sent a Teddy bear, dubbed “Illie Willie,” along to keep him company. Each treatment Sirois hangs onto Illie instead instead of the rubber ring patients typically clutch while the protons do their work. During the day he hangs out with another bear brought by Sharon Hall, Provision hospitality coordinator.

“There have been nothing but positive things coming here,” he says.

Provision Chairman & patient were college classmates


As Paul Dyer scanned through a coffee table book about Knoxville while waiting in the lobby at Provision Center for Proton Therapy for his treatment, a name suddenly seized his attention: Terry Douglass.

The chapter was about Provision and outlined the role Douglass, chairman and founder, played in its start-up as well as the prior successful start-up and sale of CTI. That company, now owned by Siemens, developed and brought positron emission tomography, or PET scanning, to the healthcare market.

“I knew it had to be the same Terry Douglass,” Dyer says.

More than 50 years before, the two were classmates at the University of Tennessee’s School of Engineering—Douglass in electrical engineering, Dyer in the mechanical engineering program.

Dyer says he had no clue Douglass was the entrepreneur behind Provision before he traveled from Eagleville, a small town in middle Tennessee, for treatment. At a recent reunion with some fellow classmates, he says, he had learned about Douglass’s involvement with CTI.

“We always knew he would do something important,” Dyer says.

Although the two were in different programs, they had a couple of classes together and hung out with the same crowd.

“I always had the sinful hope that he wouldn’t do so well on tests,” Dyer says, jokingly. “He scored almost perfect and the professor would not give a curve.”

After college, the two went their separate ways—Dyer going to work for DuPont and retiring a few years ago to the family farm, Douglass going to a position at Oak Ridge National Laboratory, the first in a series of steps toward the launch of CTI. They had not seen each other since.

When he was diagnosed with prostate cancer, it was Dyer’s primary care doctor who suggested proton therapy. He found Provision online, set up an appointment and was duly impressed with the responsiveness of the staff and, especially, Dr. Marcio Fagundes, who called his doctor and then Dyer personally as he was considering whether to choose proton therapy. In the end, Dyer and his wife decided to travel the 380 round trip miles each day to Provision for treatment.

The Friday before Dyer’s graduation, he and Douglass were reunited, posing for a photo and chatting for a few minutes about old times.

“I am so blessed that people like Terry have had ideas like PET and proton therapy and that, somehow, he has pulled all this together and made it a world-class facility,” Dyer says.

For Douglass, it was a gratifying reconnection.

“It is very rewarding and humbling to know that something of which I have been a part is impacting the lives of those whom I knew decades ago,” he says. “We never know how what we do impacts others, and we should all be thankful and blessed that we can be a part of something unique that changes lives and patient care for the better.”

French doctor high on Provision, ProNova


Georges Noël’s interest in proton therapy hearkens back to the time when he met Provision Chief Medical Physicist Niek Schreuder in 1997 at a conference in Paris.

Georges, a radiation oncologist and widely published author, wrote a paper in 2005 declaring, “proton is the future.”

“That is not a new idea for me,” said Noël, director of the radiobiological lab at Centre Paul Strauss, a cancer treatment and research facility, in Strasbourg, France. Last year, he took a sabbatical from his position, to research proton therapy with plans to set up a center there.

He came to the U.S. to research protons, starting with a six month stint in Boston. He then decided to expand his experiences to other centers, taking jaunts to Jacksonville, Philadelphia, New York, Chicago, Shreveport and San Diego. He spent the last two months of his year-long tour observing and writing his report at Provision Center for Proton Therapy.

He already was familiar with Provision. In addition to his long-time relationship with Schreuder, journal articles by Medical Director Dr. Marcio Fagundes were regular reference points. He also came to learn about ProNova Solutions and the new proton therapy machines being developed here.

“I came to compare machines from different companies and show in my report what is the best one,” he says.

After his time here, Noël says he is absolutely sold on the ProNova product.

“It’s a device to treat patients and to treat patients better,” he said. “I think ProNova is at least five years ahead of the competition. I think this company is the future of protons.”

Noël said he appreciated the close collaboration among clinicians and ProNova development staff as well as the attention paid to the comfort of both the patients and the technicians in the proton therapy equipment’s design.

And, at Provision and ProNova, everyone has the same goal, he said.

“To think that what the physician wants, the physicist wants, what the technician wants is for proton therapy to work better,” he said.

That mindset makes ProNova machines attractive for an institution that is focused on innovation as well as treatment. Noël said he believes the equipment will be most compatible with whatever research track he might want to take, whether testing better treatments, developing databases or coming up with a dose calculation system. ProNova’s entrepreneurial approach to making a new and better machine makes it ideal for making advancements in the field of proton therapy.

“To create a company from nothing,” he said, “that’s always marvelous to me.”




Fall Provision Proton Post delivers news, healthy tips


The latest edition of Provision’s quarterly newsletter comes packed with news about our patients, treatment options and advice from Provision’s nutritionist on how to keep it healthy in the upcoming holiday season.

In honor of breast cancer month, we profile Mary Bagley, a Stage 3 breast cancer patient who was successfully treated at Provision—and through it all was able to carry on her busy lifestyle! And learn about a new group, the Proton Gals, formed to support women cancer survivors who have gone through or completed proton therapy We talk to Dr. Marcio Fagundes about the new hydrogel product that’s sparing prostate cancer patients the daily “balloon” encounter and protecting them from unwanted effects of radiation on sensitive organs. Get to know the smiling face and caring person of Kristin Coffield, Provision manager of patient services, and how she came to leave a career in five-star hospitality to care for cancer patients. Learn how Dr. Allen Meek came to start a farm but ended up helping start a proton cente. And read about all of the Kentucky patients who’ve became fans of, and advocates for, Provision Center for Proton Therapy.

Staying healthy is an important part of successful cancer treatment and cancer prevention, and in this issue we look toward the upcoming holidays. Thanksgiving, Christmas and New Year’s are always a challenging time to keep up an exercise routine and keep away from extra calories. That can be especially true for patients who are away from home. In this issue, Nutritionist Casey Coffey, talks about multiple ways to address the unhealthy temptations of the holiday season—as well as how to combat the extra stress the season can deliver. Below are some more suggestions for ingredient substitutions as well as simple, delicious recipes (some you can even prepare at your ‘home away from home’!)

Happy reading!


Individual Protein Cheesecake

6oz Chobani plain 0% Greek Yogurt
1/2 Tbsp Jell-O sugar-free instant pudding mix – cheesecake

1/2 cup fiber bran cereal
4 Tbsp water
1 Tbsp unsalted almond butter
1/4 tsp stevia
1/4 tsp cinnamon
1/8 tsp nutmeg

Add the cheesecake flavored pudding mix into the yogurt and stir until well combined. Set yogurt mixture aside. In a food processor or blender, grind the bran to a fine texture. In a small mixing bowl, add the ground bran with all dry ingredients, (stevia, cinnamon, and  nutmeg) and mix evenly. Then add the almond butter and water and stir until it becomes moist and sticky. If the batter is still crumbly, add additional water in 1 tsp increments until desired consistency is achieved. Pour the crust mixture into a small 4in circular pan. Pack the crust along the bottom and sides of the dish to create a pie shape. Pour the filling on top of the crust and smooth evenly along the top. Refrigerate for at least 20 minutes and enjoy cold.


Apple Pie Parfait

1 small fuji apple
6 oz Chobani 0% Honey Greek Yogurt
1/2 cup cooked chilled quinoa
2 Tbsp walnuts
1/4 tsp cinnamon

Cook quinoa to package instructions and refrigerate beforehand. Chop the apple into small chunks. Place apple chunks in a microwave safe bowl, and sprinkle with cinnamon. Cover with saran wrap and microwave for 1-1.5 minutes until apple becomes soft. Stir and set aside. In a glass jar, layer half of the yogurt along the bottom, followed by half of the quinoa, walnuts, and apple mixture. Repeat layers to create a parfait and store in the refrigerator or enjoy warm.

Keep reading to find more recipes, plus healthy ingredient substitutions!


ProtonStories: Earl Malpass


For Earl Malpass, cancer treatment at Provision Center for Proton Therapy was something of a vacation

The pastor and mission pilot has lived in Alaska for 15 years, the past three of which he has spent in Manley Hot Springs where he and his wife, Lynn, live without running water through the long arctic winters.

“We go through 11-15 cords of wood in the winter,” Malpass says. “We just got electricity, and life has gotten a little easier.”

The communities he serves as pilot and director of Mission Air Care, a ministry of Baptist Missions to Forgotten Peoples based out of Jacksonville, Fla., are even more remote. The purpose of the ministry is to fly mission supplies to village outposts unreachable by roads.

Initially, the Malpasses lived in Fairbanks but relocated to Manley Hot Springs, selling their house and buying a partially-built cabin, to support the start of a new church there.

Earl Malpass

Malpass discovered he had prostate cancer when his PSA rose sharply, and he traveled to the lower 48 to seek medical care. He consulted a couple of cancer treatment centers, including one with proton therapy capabilities—but poor customer service, he says— before discovering Provision. (more…)

Provision patient has pre-treatment health makeover


When Hal Livergood came to Provision for treatment of his prostate cancer last February, he discovered he was living just two miles from the only proton therapy center in the Southeast. He was impressed by the brand new facility—“like coming into a resort,” he says. His doctor and personal research told him protons were the best treatment option for his disease.

There was just one problem.

“Dr. Fagundes said, ‘You need to lose weight,’” Livergood says, of Provision Center for Proton Therapy’s medical director, Marcio Fagundes. Otherwise, treatment would not be an option.

At 455 pounds and faced with a life-threatening disease, he wasted no time.

He met with nutritionist Casey Coffey at Provision Health and Performance, adopted a clean, real, whole foods diet and began exercising two hours a day—cardio in his home pool spa plus a strengthening regime.

“I lost 50 pounds in just a few months,” Livergood says. By the time he was ready to start proton therapy, he had lost 90 pounds in all. His edema disappeared. He felt better.

“Between Casey and Dr. Fagundes, they’re saving my life in more ways than one,” he says.

Livergood’s case may have been extreme, but early research is showing that tackling lifestyle changes prior to treatment can help improve long-term outcomes for cancer patients.

A recent article in the Washington Post documented this “pre-habbing” phenomenon, citing a study in the journal Anesthesiology that showed patients diagnosed with colo-rectal cancer who adopted a program of exercise, nutritional counseling and relaxation four weeks prior to surgery experienced better recovery than those with eight weeks of rehabilitation following the procedure. Research findings for non-cancer-related operations indicate the same, although more study is needed to determine the broader impacts of pre-treatment lifestyle interventions.

Some research shows a positive impact of healthy lifestyle choices during cancer treatment. For example, exercise has been shown to help alleviate fatigue in breast cancer patients and relaxation exercises help improve mental health and sleep patterns for cancer patients. Other research shows improved immune response and response to cancer treatment with particularly dietary supplementation or interventions.

In spite of the lack of studies into the impact of diet on cancer treatment outcomes, Coffey says “sugar is the only fuel cancer can survive on,” so she advocates a diet in which her clients that reduces carbs and focuses on proteins and whole, unprocessed foods. She also works with patients to identify foods they enjoy and build a plan around making lifestyle change workable.

“I had lost thousands of pounds over my lifetime,” Livergood says, with diets ranging from liquid to fat free. But after learning about the chemical reactions of the food in the body, necessary balance between protein, carbohydrates and fat he’s made changes for the long-term. And he says he doesn’t even want the junk food he once ate on a regular basis.

“The goal is to control carbohydrate intake.  We need a balance in nutrients, protein, fat and carbohydrate,” Coffey says.

When patients understand the way food affects their health and make changes for the right reasons, “the desire is just not there,” she says. “”You also have that thought process, is it really worth it?”

“’If it’s killing me,’ I think, ‘I don’t want to eat it,’” Livergood adds.

Support at home has also been crucial, and Livergood’s wife, Nancy Lee, has been there every step of the way—losing 18 pounds in the process herself. Coffey took her to Trader Joe’s, patient consults frequently include a grocery shopping trip, showing her products that support their new lifestyle.

“It’s one thing to sit in a room with somebody,” Coffey says. “I say, ‘I want you to start shopping like you would normally shop. What does it look like when you’re trying to implement something? We are so programmed to our own pattern of shopping and eating, and it’s eye opening for patients and their families to start looking at food in a new way.”

Now that he’s in treatment for his prostate cancer, Livergood says he is suffering through a low residue diet, a low-fiber regimen required for prostate cancer treatment that requires patients to cut out legumes and whole grains and reduce dairy consumption. The treatment and related hormone therapy have also left him feeling fatigued and limited his exercise routine.

Once he’s done, however, he plans to tackle the weight loss anew.

“I’ve got another 120 pounds at least to lose,” he says. “I’ve got to stay on the program.”

Provision patient enjoys “summer camp” experience with protons


 We welcome today’s guest blog by patient and Provision graduate Michael Swiatek. Today he completed treatment for prostate cancer.

This has been a very different experience than what I expected. I’m here for medical treatment in a facility that seems more like a social hall. My wife Maureen was down here the first week helping me set up the apartment and I felt like I was being checked into a summer camp. I was, it’s called Camp Proton.

At Camp Proton I arrive at the main lodge each morning and start my first activity of puzzle building. Later the camp counselors (Jennifer and Sheri) escort me to the next activity. They teach me a new way to wear my bathrobe and take me over to the gantry ride. There they have stickers for me that I can wear. We also get to play with balloons, but it’s not what I expected. I then lay down on the motion table for a ride where I get to see the laser light show, watch the gantry spin around and try to guess when the pop up targets will come out of the wall. This of course is all done to a music score emanating from the walls.

Before you know it you come back to rest from where you started. Now it’s time to go back to the main lodge for a hot drink and animal crackers.

There is plenty of time to socialize with the other campers before lunch is served in main lodge loft. There are many camp directors, mine is Dr. Fagundes. They will sit down and talk with you about how you are enjoying and participating in the camp activities.

There are also weekly talk sessions with science professor Niek Schreuder who will challenge your imagination with images of protons racing about. I was surprised to find out that the Bragg Peak was not one of the Smoky Mountains.

For me, my stay is over and now I get to go back home and tell all the neighborhood kids how I spent my summer vacation.

Goodbye camper buddies.


Center for Biomedical Research Partners with Ackerman Cancer Center in Clinical Registry


The Center for Biomedical Research is partnering with the world’s newest proton therapy center as part of a clinical meta-registry for clinical outcomes and long-term follow-up of cancer patients receiving proton therapy.

Ackerman Cancer Center has joined the registry study developed and managed by the  Center for Biomedical Research in collaboration with the Provision Center for Proton Therapy. The registry study meets all guidelines as outlined in the AHRQ’s guidelines for Registries for Evaluating Patient Outcomes.

“With the PRO 0425 study, we are collecting data that will allow us to compare information across disease sites and treatment modalities and provide a unique window into the long-term effectiveness of proton therapy,” said Marcio Fagundes, M.D., medical director for Provision Center for Proton Therapy and principal investigator.

Located in Jacksonville, Fla., Ackerman is the first private, physician-owned practice to offer proton therapy. The center began treating patients in late April.
“It is very important to me that Ackerman Cancer Center be involved in clinical research and contribute to producing evidence based data in support of proton therapy and its benefits for patients,” says Scot Ackerman, M.D., medical director of Ackerman Cancer Center.

The Center for Biomedical Research  (CBR) specializes in the management of clinical trials and has a lengthy history of managing groundbreaking clinical trials such as Herceptin, Avastin, and most recently Imbruvica of which CBR was the only clinical research site in the Southeastern United States. The Center for Biomedical Research has managed hundreds of clinical trials with a particular focus on medical oncology, proton therapy and PET imaging. CBR is regionally noted for its expertise in conducting pharmaceutical trials targeting smaller, rare cancers with specific tumor mutations. CBR and its oncology partners are often selected by major pharmaceutical sponsors and clinical research organizations (CROs) as a regional clinical research site for their most promising cancer therapeutics. The Center for Biomedical Research is a member of the National Cancer Institute’s National Clinical Trial Network (NCTN) as well as the following NCI groups;

  • NRG Oncology
  • Eastern Cooperative Oncology Group (ECOG)
  • Children’s Oncology Group (COG)
  • Cancer Trials Support Unit (CTSU)

These organizations bring decades of experience conducting practice defining, multi-institutional clinical trials resulting in improved survival and quality of life for cancer patients.