Frequently Asked Questions

Answering Your Questions

Provision is committed to our Culture of CARE. Part of our mission to respect the dignity and value of every person includes providing resources to help you make informed decisions about your healthcare. Below you will find many of our most commonly asked questions. Our clinical staff works closely with Provision’s physicians to verify each answer to ensure quality and accuracy. If you’re asking yourself, “What is proton therapy treatment?” please contact a treatment center near you to speak with one of our Cancer Care Experts today.

Proton Therapy

Questions about proton therapy, how it works, the benefits, and how to know if you are a candidate.

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General Radiation

Questions about radiation therapy in general,  the various types, side effects and differences between proton radiation and conventional x-ray radiation.

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Cost & Insurance

Questions about the cost and payment options for proton therapy, as well as insurance coverage from private carriers, Medicare, and Medicaid.

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Proton Therapy FAQ

What is proton therapy treatment?

Proton therapy is an advanced form of radiation therapy that uses a single beam of high-energy protons to treat various forms of cancer. Just as with conventional radiation, protons treat tumors by directing radiation into the tumor site where doses of radiation destroy cancerous cells.

What is the difference between proton therapy and traditional radiation therapy?

Proton therapy is a precise form of external beam radiation therapy. Both conventional (x-ray) radiation therapy and proton therapy attack tumors by preventing cancer cells from dividing and growing causing them to die. Conventional radiation therapy uses x-rays which enter and exit the body, depositing unnecessary radiation to healthy tissue that surrounds the tumor being treated and potentially causing damage. Proton therapy uses the unique characteristics of protons to target the tumor with precise accuracy and because protons stop at the target, any exit dose of radiation is eliminated. Proton therapy makes it possible for physicians to treat the tumor with a higher, more effective dose, and reduce damage to nearby healthy tissue. Provision CARES Proton Therapy features Pencil Beam Scanning (PBS), which further increases the accuracy and advantages of proton therapy.

Why should I choose Provision CARES Proton Therapy?

Provision CARES Proton Therapy has been treating patients with proton therapy since 2014. We have treated patients from over 39 states and six countries. We currently have two cancer center locations featuring proton therapy and are setting new standards of excellence for industry best practices. We are not only growing our Provision CARES Cancer Network of centers offering proton therapy, but we are also the only proton therapy center in the world who manufacturers proton therapy equipment with our ProNova SC360, making us an expert in the proton therapy industry.

Am I a candidate for proton therapy?

If you are diagnosed with cancer you should ask your doctor about proton therapy. A consultation with one of our board-certified Radiation Oncologists can help you decide if this is the right treatment for you. To speak with a Cancer Care Expert or schedule your consultation, please contact the treatment location closest to you.

What types of cancer can be treated with proton therapy?

Many cancer types can be treated with proton therapy. Proton therapy is a non-invasive treatment for cancer, beneficial for treating patients with a localized tumor where cancer has not spread to other parts of the body, or in situations where tumors cannot be removed surgically. Proton therapy may also be an option for cases that require radiation therapy in addition to surgery, or may be combined with other treatment options.

Can children receive proton therapy?

Yes. In fact, The American Society of Radiation Oncology (ASTRO) ranks using proton therapy to treat solid tumors in pediatric patients with the highest importance (ASTRO Model Policy, 2014) because a child’s tissue is more sensitive to radiation, resulting in higher potential for negative effects. Since proton therapy reduces the dose of radiation received to nearby healthy tissues and organs, using proton therapy in children, adolescents and young adults has been shown to lower long-term negative side effects in many cancer types. Visit our pediatric cancer page to learn more about the benefits of proton therapy for pediatric cancer.

What is treatment like with proton therapy?

The goal of our proton therapy team is to make your treatment as comfortable as possible. During treatment you will be positioned on a table, where our team of radiation therapy doctors will use various cushions and positioning tools to keep you from moving out of position, while still maintaining a level of comfort. While the time under the proton radiation is just a few minutes, total treatment time is usally 20-30 minutes for each session. Patients can request music to play during their sessions to personalize their visits and provide more comfort.

How long does a proton therapy session last?

A treatment session usually lasts a total of 20-30 minutes. First, your team will position you to receive your treatment. Then, you will receive your proton therapy dose which typically takes just a few minutes to deliver.

How many proton therapy sessions will I need?

Most patients have treatments that last 6-8 weeks with five sessions per week. Since side effects are minimal, patients can typically maintain their normal lifestyle and continue to work and go through their daily routines during treatment.

Will proton therapy impact my ability work?

Since negative side effects of proton therapy are minimal, most patients can continue to work throughout the course of their treatment.

Can proton therapy be combined with other treatment options?

Yes. Proton therapy can be used in conjunction with other cancer treatment modalities, such as surgery and chemotherapy.

What is the success rate of proton therapy?

More than 800 clinical studies have been published on proton therapy, with the number of studies expanding every year. To learn more about the benefits of proton therapy for specific cancer types, please visit our Proton Benefits page.

How many patients have been treated with proton therapy?

Proton therapy has been in clinical use since the 1970s. According to the National Assocation of Proton Therapy, over 200,000 patients have been treated with proton therapy worldwide, and more than 75,000 of those were in the United States. The Provision CARES Proton Therapy has treated more than 4,000 patients since 2014.

What are the side effects of proton therapy?

Because proton therapy delivers a minimal radiation dose to nearby healthy tissue and organs, there are fewer side effects when compared to traditional radiation therapy. Depending on the tumor site, patients may experience skin irritation and hair loss in the areas of direct contact with the proton radiation. Most patients can continue to work, exercise and maintain their daily routines during the course of their treatment.

Is proton therapy painful?

Most patients report little to no pain or discomfort during proton therapy treatment. You cannot see or feel the proton beam and treatments usually only last a few minutes.

Can proton therapy be used to treat recurring cancer?

For a local recurrence, meaning cancer has come back in the same area or near the original site, treatment with traditional radiation is not typically an option. This is because the nearby tissue may have already received the maximum lifetime radiation dose it can withstand during the initial course of cancer treatment. Because proton therapy delivered with pencil beam scanning has precise capabilities to deliver radiation directly to the tumor with minimal dose to nearby healthy tissue and organs, it can often be used to treat local recurrences. Physicians can plan the path of proton therapy with precision to reach the cancer target while avoiding the previously irradiated healthy tissue.

Is proton therapy FDA approved?

Yes. Proton therapy was FDA approved for use in the United States in 1988.

Is proton therapy experimental?

Proton therapy is not experimental. Patients have been treated with proton therapy for more than 65 years. The first proposal to use protons for medical treatment was in 1946 by Physicist Robert R. Wilson, PhD. By the 1950s, the first patients were being treated with proton radiation and there would be much research and development to continue over the next 40 years.

The FDA approved proton therapy for use in the United States in 1988. The first proton therapy center in the U.S. opened in 1990. In 2014, Provision CARES Proton Therapy Knoxville became the 13th center in the country, followed by Provision CARES Proton Therapy Nashville in 2018, the 29th proton center in the U.S. More than 200,000 people have been treated with proton therapy worldwide.

What is pencil beam scanning?

Pencil beam scanning (PBS) allows radiation oncologists to treat a tumor using the proton beam at a precisely configured range and adjust the intensity of the beam to achieve the appropriate dose, then stop the beam in its tracks, limiting the collateral damage. As a result, vital organs surrounding the cancer are better protected from unnecessary radiation, thus minimizing or completely avoiding treatment-induced side effects, such as nerve damage with resulting neurologic dysfunction, as well as avoiding other complications like breathing difficulties, feeding tubes, nausea, impotence, secondary cancers and more.

PBS technology has truly revolutionized proton therapy, offering increased flexibility in dose shaping and improved dose conformality, enabling clinicians to treat larger and more complex tumors. With PBS, a proton beam spot moves by magnetic scanning, while the beam intensity is adapted simultaneously, so that protons are delivered to one specific spot at a time about the size of a dry-erase marker tip within the patient’s body. By connecting a series of these spots, layer by layer, the beam can precisely conform to the shape of the tumor.

Previous methods delivered the dose of radiation to the entire site at one time, making it difficult to accommodate for variations in tumor structure or volume. Pencil beam scanning reduces the radiation dose by 25 percent when compared to existing methods of proton delivery.

General Radiation FAQ

What is radiation therapy?

Radiation therapy is a form of cancer treatment that uses high energy waves to kill cancer cells and shrink tumors. Two types of radiation therapy that use external beams are traditional (x-ray/IMRT) radiation and proton radiation. Traditional radiation therapy uses photons, while proton radiation therapy uses protons. Due to the unique characteristics of protons, proton radiation enters the body at a lower dose and delivers the highest dose in the tumor with no exit dose. Unlike traditional radiation therapy, protons allow for minimal radiation to nearby healthy tissue and organs.

How does radiation therapy work?

Radiation therapy works by causing damage to the cancer cells’ DNA. This DNA damage prevents the cancer cells from dividing and growing, causing the cells to die. Radiation can be delivered to cancer cells in several ways. External beam radiation therapy, like proton therapy or x-ray therapy, works by using a machine to direct an external beam of high-energy radiation through the body to the tumor. You cannot see or feel the beam. Internal radiation therapy, also called Brachytherapy, uses a needle or catheter to implant a radiation source through a sealed seed, ribbon or capsule directly into or near the tumor inside your body. These implants can be permanent or temporary. Systemic radiation can also be used by giving a radioactive drug orally or intravenously which then travels throughout the body.

Is radiation therapy painful?

In general, radiation therapy is not painful. Some patients might have slight discomfort during treatment. The most common side effects of radiation treatment are fatigue and skin irritation. These can vary depending on the type of radiation therapy you receive.

What are the most common side effects of radiation therapy?

The most common side effects of radiation therapy are fatigue, as well as skin irritation and hair loss at the area being treated. Long-term side effects will very depending on the type of radiation therapy you receive and your individual diagnosis. Radiation therapy using protons can minimize the dose of radiation received by nearby healthy tissue and organs, thereby reducing side effects as compared to conventional radiation therapy.

What is external beam radiation therapy?

External beam radiation therapy (EBRT) is the most common form of radiation therapy. Both conventional radiation, using x-rays or photons, and proton therapy radiation, using protons, use a machine to generate and deliver an invisible high-energy beam of radiation through the body to the tumor site. Unlike photons used in conventional radiation, protons are positively charged particles with unique characteristics that allow for a minimal dose of radiation to be received in nearby healthy tissue and organs.

What is internal radiation therapy?

Internal radiation therapy, also referred to as brachytherapy, is a form of radiation therapy that involves implanting radioactive material directly into the tissue close to or within the tumor. These radioactive materials are sealed inside a sead, pellet, wire or capsule.

What is brachytherapy?

Brachytherapy, sometimes referred to as internal radiation therapy, is a form of radiation therapy that involves implanting radioactive material directly into the tissue. These radioactive materials are sealed inside a seed, pellet, wire or capsule, then delivered inside the body through a needle or catheter. Brachytherapy implants can be temporary or permanent.

How do radioactive implants work?

Radioactive implants are used in brachytherapy, also referred to as internal radiation therapy. These radioactive materials are sealed inside a seed, pellet, wire or capsule and are implanted into the tissue using ultrasound guidance.

What is CyberKnife?

CyberKnife uses a lightweight linear accelerator (LINAC) mounted to a robotic arm to deliver a dose of radiation to the targeted tumor. While CyberKnife does provide the ability to administer multiple radiation beams, it still uses x-ray, or photon, radiation therapy which has a higher entrance and exit dose than compared to proton therapy. Protons have the unique characteristic if being positively charged particles, allowing for a minimal entrance dose of radiation. Also, since proton radiation stops at the tumor, there is no exit dose. This results in fewer side effects as compared to any form of conventional, or x-ray, radiation therapy.

What is FLASH radiation therapy?

Still in development, FLASH radiation therapy is a new technology being tested in a number of European science institutions. It delivers an ultra-high dose rate of radiotherapy, given to the body in seconds rather than minutes. It has not been tested in humans at this time.

Cost & Insurance FAQ

Provision CARES Proton Therapy has a team dedicated to help you navigate the process of coverage for proton therapy. We work closely with all insurance companies to take all the necessary steps toward coverage. Our Financial Services Team is professionally trained and experienced to work with your insurance carrier. Each individual case is different, so we urge you to contact our Cancer Care Experts at 1-833-6-PROTON to schedule a consultation or connect you to our Financial Services Team to learn about your coverage benefits.

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Does insurance cover proton therapy?

Proton therapy is covered by most major insurance carriers, and coverage continues to expand with major carriers based on the benefits of proton therapy treatment. Insurance coverage varies based on many factors, including cancer type, stage, and your specific insurance benefits. Provision CARES Proton Therapy has a Financial Services Team dedicated to help you understand and learn more about your individual insurance plan and proton therapy coverage. To learn more, contact a Cancer Care Expert today toll-free at 1-833-6-PROTON.

How do I find out if my insurance company will cover proton therapy?

The first step is to speak with one of our Cancer Care Experts to talk about your diagnosis and insurance carrier. It may be best for you to schedule a consultation or connect with a member of our Financial Services Team. Each individual case is different. However, our dedicated team will work closely with your insurance company to provide all the necessary steps toward coverage.

How does Provision offer support in working with my insurance company?

Provision CARES Proton Therapy has a dedicated team that will work closely with your insurance carrier to navigate all steps necessary toward coverage. We will contact your insurance company on your behalf to discuss your specific coverage and benefits. We will then relay this information to you as we move forward with your care.

Will my insurance cover proton therapy if I am out-of-state?

We have treated patients from all over the United States and internationally. Coverage for proton therapy varies based on your specific diagnosis and insurance benefits, and continues to expand with major carriers in the U.S. Our Cancer Care Experts can help you learn more about your coverage benefits before scheduling and traveling for a consultation.

Does insurance cover my consultation?

Most insurance companies will cover your consultation. Coverage depends on your individual insurance carrier. Call today to speak with a Cancer Care Expert to learn more about your specific coverage benefits for a consultation.

Does Medicare cover proton therapy?

In general, Medicare covers proton therapy. For more information about Medicare coverage of your specific cancer diagnosis, please contact us toll-free at 1-833-6-PROTON to speak with one of our Cancer Care Experts today.

Does Medicaid cover proton therapy?

We work with Tennessee Medicaid and are able to obtain coverage and approval for all in-state pediatric cases. Adult Medicaid patients require a referral from another physician. Once referred, we will work with the insurance carrier to secure approval. Some diagnoses are easily approved. For others, our Financial Services Team will work on your behalf to provide all the necessary steps toward coverage.

Are there self-pay options if my insurance does not cover proton therapy?

There are self-pay options. The cost varies based on many factors that impact your treatment plan, such as diagnosis, stage of disease, and prescription of treatment dose. Our Financial Services Team can help answer your questions and work with the insurance companies on your behalf. To learn about your options, call us toll-free at 1-833-6-PROTON to speak with a Cancer Care Expert today.

What is the out-of-pocket cost for proton therapy?

Each patient's case is unique and the out-of-pocket cost will be determined based on their specific insurance coverage benefits. Provision offers payment options to help make this more achievable for our patients. To learn more about coverage benefits, contact one of our Cancer Care Experts toll-free at 1-833-6-PROTON.