Male cancer patient using telehealth

Telehealth can help cancer patients during coronavirus pandemic

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Trying to navigate your cancer care journey is challenging enough without the added stress of a global pandemic.  Normally, you would schedule an in-person consultation with a physician to discuss your treatment options. Understandably though, many cancer patients now have reservations about going out in public during the coronavirus pandemic. Thankfully, telehealth provides a safe way for someone with cancer to continue moving forward with their care in a timely manner.

Provision CARES Proton Therapy implemented an expanded telehealth program in March 2020. This has allowed us to continue helping cancer patients in a safe environment, while also limiting the number of people at our centers. Since March, our physicians have conducted many telehealth consultations and virtual follow-up appointments. Our telehealth program allows someone who has been recently diagnosed with cancer to remain at home and speak directly to a physician through a video connection about their diagnosis, treatment options and next steps.  Our Cancer Care Experts can help patients through this process.

CANCER CARE PROVIDERS TURN TO TECHNOLOGY

The coronavirus pandemic has changed many aspects of the healthcare industry. When the outbreak began to gain momentum in the United States, hospitals made operational changes to accommodate a potential influx of COVID-19 patients. Many general practitioners and specialists began to postpone well-visits and elective procedures. Specialty healthcare providers, including cancer treatment centers, also made adjustments to keep their patients, employees and visitors safe. Many of those providers, including Provision CARES Proton Therapy, turned to technology, broadening their ability to provide cancer care through the use of telehealth.

A recent survey indicated nearly half of all physicians are now communicating with patients through telemedicine, a stark rise from just two years ago. The survey, conducted by Merritt Hawkins, a physician search firm, in collaboration with The Physicians Foundation, sought to learn how COVID-19 is impacting physicians and how they are responding. It found that 48 percent of physicians are using telemedicine with patients. A similar study by The Physicians Foundation in 2018 had that number at just 18 percent.

The increase in telehealth usage was aided further after the Centers for Medicare & Medicaid Services announced they would broaden access to Medicare telehealth services as part of the federal government’s emergency pandemic response.

CANCER & TELEHEALTH FROM A PHYSICIAN’S PERSPECTIVE

James Gray, MD, FACRO, Medical Director at Provision CARES Proton Therapy NashvilleSince the use of telehealth for medical appointments is becoming more common, we’re providing some firsthand insight into how it works and why it’s such a valuable tool for cancer patients. We asked the medical director of Provision CARES Proton Therapy Nashville, Dr. James Gray, a few questions about his experience with telehealth during the pandemic. Dr. Gray is a board-certified radiation oncologist who has spent 30 years studying cancer and helping patients navigate their cancer care journey.

What are your general thoughts on the use of telehealth for cancer care?

“I believe telehealth substantially contributes to our ability to communicate with patients.  While this applies across all areas of healthcare, it particularly applies to services which are restricted or to which there is limited access.  Proton therapy is a prime example of this.  I can interact with and advise patients who might not otherwise find it reasonable or even possible to travel to our center, or any other proton center.  Such patients may find that proton therapy has possible benefits for their circumstance and might make the trip worthwhile.”

What kind of feedback have you heard from cancer patients who’ve used telehealth?

“Generally good.  Telehealth allows us to help prevent a delay in the cancer patient’s process. As long as an in-person assessment is not necessary, then a telehealth consult allows me to counsel a patient quite well based on medical records and images forwarded to us in advance.  If equally feasible, an in-person visit is still superior for this communication, but a telehealth visit allows me to get the message across and answer the patient’s questions.”

What would you tell a patient who’s nervous about trying a telehealth appointment?

“I reassure the patient and family members that the telehealth visit can start the process of managing their cancer, but more interactions will follow in order to answer subsequent questions and direct further workup of their disease.  If the reason the patient feels nervous or uncomfortable is simply a technology concern, we can have our administrative staff reach out to them and their family to provide assistance.”

As a doctor, how has telehealth helped you during the coronavirus pandemic?

“It allows me to interact with more patients, and in a more timely manner, than I otherwise could due to visitation restrictions, or perhaps just logistics of travel for the patient.  I receive gratification from counseling patients through a rough time, always hoping to alleviate concerns and fears about issues they don’t understand and taking away some of the uncertainty of their next steps.”

Are there other ways cancer care providers are taking advantage of technology during the pandemic?

“Besides avoiding unnecessary contact between care providers and patients, physicians have suspended our in-person meetings called tumor boards or tumor conferences.  But there is a silver lining to this change because we have been forced to become better at virtual meetings, allowing us to exchange ideas and recommendations through audio/visual software.  Again, in-person meetings will likely always be preferable when reasonable, but the ability to attend the meeting virtually from your office or home has been given a big boost during this time.  Ultimately, comfort with this type of meeting attendance makes the meeting more accessible.  And the more we interact, the better we explore all options for our patients.”


To learn more about Dr. Gray and the other board-certified radiation oncologists at Provision CARES Proton Therapy, please visit Our Physicians page. If you are interested in learning more about proton therapy or scheduling a telehealth consultation, please call the Treatment Location closest to you and speak with one of our Cancer Care Experts.

Provision doctor diagnosed with cancer, chooses proton therapy for his own treatment

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This story starts the way a lot of cancer stories start. A visit to the doctor for an unrelated issue. A few tests. And then, while trying to solve one problem, the doctor discovers another – a red flag.

That discovery sparks a journey down a road far too many have traveled. First, more trips to the doctor. Then more tests. And then the waiting. Waiting with fear and uncertainty – hoping for the best, but preparing for the worst. Until eventually, the wait is over and the news is in…

It’s cancer.

And from there, this story continues down a common path. Mulling over questions like “How bad is it?” and “How do I deal with this?” Determining the options and choosing a treatment. And of course, fighting the cancer.

There’s something uncommon about this story, though – the person making the journey. Because he’s literally been down this road hundreds of times before. He knows the roadmap better than most, because he’s guided people through it for decades.

The only difference this time? He’s no longer the guide. This is his journey.

FROM DOCTOR TO PATIENT

James Gray, MD, FACRO, Medical Director at Provision CARES Proton Therapy NashvilleDr. James Gray is a board-certified Radiation Oncologist and the Medical Director at Provision CARES Proton Therapy Nashville. His career includes work with the National Naval Medical Center and the National Cancer Institute. He began practicing radiation oncology in Nashville in the mid-1990s, including membership in Tennessee Oncology, one of the largest privately-held physician groups in the country. He has established his reputation as a pioneer in the industry, performing many advanced procedures never-before-seen in the region.

Accomplishments and accolades, aside, it’s Dr. Gray’s passion and commitment to his patients that define him. He’s spent 30 years studying cancer and helping patients navigate the difficult path of fighting it.

“I get to work with patients in a time of dire need for them. They undergo a diagnosis of cancer, and this is terribly frightening for most people to accept and move forward,” says Dr. Gray. “Helping someone move through that. Counseling them. Making them understand their disease. That’s what brings joy to me – the actual effort of bringing this understanding to those patients and then bringing the best possible care to them. That drives me every day.”

Then, in 2019, he visited a physician to check out a minor health issue. During that visit, Dr. Gray underwent a PSA level screening. Much to his surprise, the levels came back slightly elevated – a possible indication of prostate cancer.

“I realized with that PSA level, I needed to pursue this, and I went to see another physician – an outstanding urologist – and he proceeded with a diagnostic work up. That led to some other lab tests, an examination and then a biopsy.”

Dr. Gray recalled the anxiety he felt during the days following the biopsy. “You’ve got to wait maybe 3 or 4 days to get the pathology results back. I got to live firsthand that trepidation – that worry of, ‘Oh gosh. I hope it’s not cancer.’”

Unfortunately, though, it was cancer. Prostate cancer.

“It put me in a unique position where I’ve actually counseled patients who’ve just gotten this news. I’ve counseled probably more patients in this setting than anybody else in the area. All of a sudden, I’m counseling myself. Now, I’m the patient.”

WEIGHING THE OPTIONS

After receiving the news of his cancer diagnosis, Dr. Gray says he had a 30-year head start on the typical patient. As an established Nashville oncologist, he already had a strong grasp on the answers to questions like, “What does this mean for my life?” and “Am I going to die from this?” However, it was still important for him to remain objective, gather information about the severity of his cancer, then step back and make a clear treatment decision.

The initial decision for most prostate cancer patients is to determine whether the cancer is actually worthy of treatment, or if it would be more appropriate to observe it through active surveillance. In Dr. Gray’s case, he felt the cancer was threatening enough to treat immediately.

The next big divide – the “fork in the road,” as Dr. Gray calls it – is to decide whether to remove the prostate surgically or treat the tumor with radiation therapy.

“For me, that was not a difficult decision,” he says. “Knowing what I know about the likelihood of getting rid of the disease and the likelihood of having any kind of consequences from the treatment itself, I knew pretty quickly that I wanted to have radiation.”

That led to his next decision – choosing a radiation therapy method. There are many options for prostate cancer patients, including traditional x-ray radiation, radioactive seed implants (brachytherapy) and proton therapy.

For Dr. Gray, this was another easy decision. “One of the key advantages of proton therapy is that we’re putting (radiation) into the tumor with as little unnecessary dose to other tissues as possible. That inherently reduces the possibility of side effects – fatigue, difficulty with urination or bowels in my circumstance. So statistically, I am convinced. I’ve seen the data. I know what I consider to be the best treatment for prostate cancer, in my particular setting, was a proton therapy treatment system.”

“And fortunately, I happen to work at a proton system.”

WORK-LIFE BALANCE

They say it’s important to have a good work-life balance in your career. In Dr. Gray’s case, those two worlds collided as soon as the radiation oncologist began his proton therapy treatment in Nashville.

“I could actually go to work every day and receive a treatment – close to six weeks of treatment – but I was just going to work. And for 20 or 30 minutes, I stepped into the patient role, had my treatment, then went back into the doctor role.”

Dr. Gray remembers the transition from doctor to patient being fairly easy, mainly because of the trust he had in the treatment itself, as well as the Provision CARES team performing the treatment.

“For a lot of patients, they have to slowly gain the trust in me as their physician. They have to gain the trust in the people that are going to do their treatment. They have to gain the trust in the technology,” notes Dr. Gray. “I didn’t have those misgivings. I knew that when I was being treated, very bright people were watching over the treatment and making sure it was done right. I know how competent, outstanding and professional those people are, so I didn’t have any qualms about that.”

In fact, Dr. Gray’s positive attitude during his treatment actually helped the other staff members deal with a situation in which their colleague, friend and mentor was battling cancer – and they happened to be the ones treating it.

“I’ve never been in that situation before where you’re treating someone that you know so closely,” remembers Justin Pigg, Radiation Therapy Manager at Provision Nashville. “But to Dr. Gray, he just wanted to be treated like any other patient. He wanted the patient experience.”

“He was really calm and really strong through it, and I think that helped everybody else be calm, as well,” says Valerie Bohannon, the proton center’s Patient Concierge.

That sense of calm among the team was critical, as just about everyone at Provision Nashville had some role in Dr. Gray’s treatment.

“It’s all the way from the top to the bottom,” Dr. Gray says. “Every member of this staff had something to do with making sure my treatment went well. They all wished me well. They all asked me how I was doing. They were genuinely concerned about this.”

And that concern – that culture of care – is what Provision is all about. Dr. Gray hears it from his patients all the time.

“They will tell me how impressed they are from the moment they walk in the door to the time they’re leaving the center. They felt like they’ve been enveloped in care. And I felt the exact same way. It was obvious to me that I was brought into that care – that love – that people wanted me to do well.”

WALKING IN THE PATIENT’S SHOES

Dr. Gray, a Nashville oncologist, completing his proton therapy treatment at Provision CARES NashvilleDr. Gray successfully completed proton therapy in January 2020, placing him in a rare category of radiation oncologists who’ve actually been through the very cancer treatment in which they specialize. He says the entire experience impacted the way he’ll approach his role as a doctor going forward.

“It was enlightening. Going through the treatment myself gave me quite a bit of a different perspective. It’s important for me to understand that my personal experience can be translated only some degree to my patients, but at least having a taste of it allowed me to understand a bit more how they see it – how they experience the whole treatment process.”

That “taste” of proton therapy, as he calls it, will now be another tool for a Nashville oncologist who is passionate about making this effective and successful treatment available to as many people as possible.

“Some people suggested I had to choose proton therapy because I work at a proton therapy center. No, not necessarily. I’m not going to compromise my own good health just to make a point in my professional career. I wanted to have the best outcome, and I genuinely believe my best outcome would be achieved through the use of proton therapy.”

And with 36 operating proton centers across the country, why did he choose to be treated at Provision CARES Proton Therapy Nashville? He says that was another easy decision.

“Why would I leave here when I know I’ve got great people here to treat me. I can get world class treatment by world class people just downstairs from my office. Why wouldn’t I take advantage of that?”

Provision Team Members Participate in the National Association of Proton Therapy Convention

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The National Association for Proton Therapy (NAPT) held its seventh annual proton conference March 24-27, 2019, at The Biltmore Miami – Coral Gables, in Miami, Florida.  Founded in 1990, the National Association for Proton Therapy is a nonprofit organization whose mission is to work collaboratively to: (i) raise awareness of the therapeutic benefits of proton therapy among patients, providers, payers, policymakers, and other stakeholders, (ii) ensure patient choice and access to affordable proton therapy, and (iii) encourage cooperative research and innovation to advance the appropriate and cost-effective utilization of proton therapy. The annual conference allows proton centers from across the Unites States to convene and discuss how to advance awareness of the clinical benefits of proton therapy for cancer patients, provide education, and advocate for insurance coverage.

This year, almost 300 physicians, nurses, therapists, proton therapy directors, managers and others involved with or interested in learning more about the cutting-edge therapy attended the conference.  The 2019 program covered a variety of interesting and informative topics including: pediatrics, marketing, legislation, insurance and appeals, and clinical updates. Keynote speaker Barbara L. McAneny, MD, President of the American Medical Association, Anne Hubbard, Director of Health Policy for the American Society for Radiation Oncology, and guest speaker Senator Marco Rubio, all described the important role and impact of proton therapy in cancer care and the medical field at large from perspectives beyond those of proton providers. It was encouraging to hear proton therapy is gaining powerful advocacy and allies in positions within the medical field as well as in the upper levels of government.

Provision entities were represented by twelve attendees. Provision representatives participated as presenters and facilitators for several of the conference breakout sessions. Rebecca Bergeron, Dr. Ben Wilkinson, Jenni Turner, Elizabeth Vanzo, Nancy Howard, Niek Schroeder, and Laddie Derenchuk were all members of panel discussions and gave presentations on topics ranging from legislation and technical developments, to clinical best practices, patient interactions, and collaboration. This level of participation by Provision representatives further demonstrates Provision’s place as an industry leader.

In addition to the presentations, discussions, and panels, George Laramore, MD, PhD, FACR, FASTRO, of the Seattle Cancer Care Alliance Proton Therapy Center and the University of Washington, was awarded the 2019 NAPT Lifetime Achievement Award in recognition of his decades of pioneering work in the field of particle therapy. In announcing the award, NAPT Executive Director, Scott Warwick, stated “Dr. Laramore has brought honor and distinction to the field of particle therapy and we are grateful for the opportunity to award him for his endless dedication and perseverance to serve cancer patients across the country and the world.”

The NAPT announced that the 2020 National Proton Therapy Conference will be held April 25-29 in Nashville, TN at The Renaissance Hotel. Provision CARES Proton Therapy Nashville will host a Reception and Tour April 27th.  Nancy Howard, Vice President Marketing & Public Relations of Provision Solutions, will act as the 2020 Conference Chair.

The National Association for Proton Therapy is the voice for the proton community. As there are now 31 Proton centers in operation and 35 centers under construction or in development, it is important for all proton centers to form a strong alliance to advocate for patient access to proton therapy.   NAPT is the vehicle that will lead our alliance forward.

New proton therapy cancer center to open across from Williamson Medical Center

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A cancer treatment center specializing in proton therapy, an increasingly popular treatment, is set to open in the summer of 2018.

Provision Healthcare, a clinical provider and developer of cancer treatments, will open a Provision CARES Cancer Center on Carothers Parkway, across from Williamson Medical Center, said Dr. Terry Douglass, Ph.D., the executive chair of Provision.

Proton therapy, said Douglass, is a form of advanced radiation technology that impairs the DNA of cancer cells and causes them to die.

Unlike traditional radiation methods, a machine called a cyclotron is used to pinpoint cancer cells, targeting diseased cells while minimizing damage to surrounding tissue.

“It’s like using a rifle compared to a shotgun,” Douglass said of the therapy.

“We developed a new technology that is a lower cost, that uses smaller and lighter technology,” Douglass said of the 200-ton machine which is used to treat cancer.

In traditional chemotherapy or radiation techniques, side effects are common. But with proton therapy, Douglass said side effects are less pronounced; he also said numerous data support the use of proton therapy, including better long-term outcomes for patients.

The treatment is becoming more common for illnesses like prostate cancer, but studies show mixed results, not conclusively supporting the treatment as better than traditional radiation.

Proton therapy centers are popping up across the country. According to the National Association of Proton Therapy, there are currently 26 proton therapy centers in operation with 11 under construction or in development.

The Franklin location will be the company’s second center in Tennessee. The original campus opened in January of 2014 in Knoxville. Planned expansions in Fort Lauderdale and Orlando, Florida, are in the works, said Douglass.

Of the decision to be based in Franklin, Douglass said the surrounding health care centers and climate of technological innovation made it a good choice, noting Tennessee Oncology and Vanderbilt as two top-notch cancer treatment centers.

Douglass said the spot on Carothers Parkway, in a central location with easy access to the interstate, would make it easy for patients from Tennessee, as well as Kentucky and Alabama, to reach the center.

“These patients are here from four to eight weeks. They get five treatments Monday through Friday, then they have the weekend off,” he said. “We were looking for a site that would be amenable to the patients.”

“Being near the Williamson County Medical Center was very important to us as well,” he continued. “Franklin has just become a hub of healthcare services.”

In addition to the center, the company will build 72,000 square feet of office space, which Douglass said will house medical companies including Tennessee Oncology and drug discovery and trials for the Sarah Cannon Cancer Center.

Mary Lou DuBois, the president of Provision Health Partners, said the location will open some time this summer, and will hire 75 to 80 employees to staff the center.

“We’re about developing a culture of care that is totally focused on the patient and walking through and with them as they’re on their journey,” she said of center’s mission.

In 2005, Provision Healthcare was founded by Douglass in Knoxville. The organization operates as a for-profit healthcare solutions company, while both the Knoxville and Franklin cancer centers are non-profits.

“New proton therapy cancer center to open across from Williamson Medical Center.” Brooke Wanser, Brentwood HomePage

cyclotron, Provision Healthcare, Franklin

Provision installs cyclotron at Nashville site

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Provision Healthcare in expanding cancer centers and advancing proton therapy to Nashville, TN, with the development of the Provision CARES Cancer Center.

After months of excavating and building construction, The Provision CARES Cancer Center in Franklin, Tenn., welcomed the cyclotron, a key component—and the largest—to the new facility. This brings the center one step closer to treating cancer patients in May 2018. (more…)

Scott Hamilton Proton Therapy Center Unanimously Approved for Nashville

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Scott Hamilton and Terry Douglass stand in an unfinished proton therapy treatment room in 2013 at Provision Center for Proton Therapy in Knoxville. Douglass and Hamilton are developing the Scott Hamilton Proton Therapy Center in Middle Tennessee. Photo by J.Miles Carey/News Sentinel

An application for a certificate of need was approved unanimously (9-0) today by the Tennessee Health Services and Development Agency for the development of Tennessee’s third proton therapy cancer treatment center.  Provision Trust, Inc. and the Scott Hamilton CARES Foundation are planning to develop and operate the first Scott Hamilton Proton Therapy Center in the United States in the city of Franklin in Williamson County.

The $109 million not-for-profit center will be open to all qualified and properly credentialed radiation oncologists, regardless of hospital affiliation, bringing proton therapy to the citizens of Middle Tennessee.  The proton center will be developed on an 11.6-acre vacant lot near Williamson Medical Center and the existing Vanderbilt-Ingram Cancer Center in Franklin.

Proton Therapy is one of the most advanced treatments available to cancer patients.  Currently, there are only 15 proton therapy centers in the United States. Provision currently owns and operates one of those 14 centers located in Knoxville.  Hamilton serves as a board member of the Provision Center for Proton Therapy.

The addition of the first Scott Hamilton Proton Therapy Center in Hamilton’s city of residence is a significant step towards a progressive new vision in cancer advocacy, awareness and treatment. The center will primarily serve 38 Middle Tennessee counties. Its secondary service area extends to West Tennessee and adjoining areas of Alabama, Mississippi and Kentucky.

Read the entire news release here.

Read coverage in the Knoxville News Sentinel here. 

Read coverage in The Tennessean here.