News and Blog

Aug

The Important Role of Dosimetrists in your Proton Therapy Treatment Plan

It only takes a few minutes for patients to receive their daily proton therapy treatment. However, for each treatment course there has been hours of prior planning to develop the best treatment plan according to the radiation oncologist’s prescription. The treatment plan comprises of the exact dose and beams and patient positioning aspects required to deliver the dose to the target volume.

Protons are positively charged particles that have a unique range of penetration into the patient’s body. This is characterized by the Bragg Peak. The Bragg Peak occurs at the point where the highest dose of radiation is delivered to the patient’s body. Dosimetrists use physics software tools to determine how to formulate the proton beam i.e. the beam energy and intensity in order for the Bragg Peak to occur at the site of the tumor. With protons, there is minimal entrance dose and no exit dose. The Bragg Peak happens at the tumor because the protons stop which makes proton radiation therapy so precise.

The dosimetry team works closely with the medical physicists and the radiation oncologists to determine the exact physics behind every single proton beam received by patients. No two treatment plans are the same. Treatments are completely customized based on the individual’s tumor, body and other factors.

One of the most important goals for our dosimetry team is to find the best treatment plan for every individual patient that minimizes the radiation to healthy tissue and critical organs. They do this using pencil beam scanning technology, where the beam of radiation, which is just millimeters wide, are controlled in position and depth in order to bypass nearby organs and targeting the tumor directly. The precision of proton therapy pencil beam scanning in conjunction with the dosimetrists who prepare the best treatment plans ensures that patients receive less radiation outside the target areas and therefore reduces side effects while maintaining their quality of life both during and after treatment.

Provision’s team of Dosimetrists in Knoxville is led by Valerie Coffman who is a board-certified dosimetrist with more than 5 years of experience in proton dosimetry. Including Valerie, Provision has a team of 4 board certified dosimetrists, two dosimetrists that just finished dosimetry training at provision and two dosimetry interns. The dosimetry team works in close collaboration with 4 board certified Medical physicists, two residents and one physics assistant.

In Nashville, Provision’s team of dosimetrists is led by Joe Simmons who is a board-certified dosimetrist with more than 15 years of experience in proton dosimetry. Including Joe, the Nashville team has 3 board certified dosimetrists and one dosimetry intern working with 3 board certified medical physicists and one physics assistant.

Together, our team of medical dosimetrists and physicists work to ensure that our patients receive the best treatment plans possible based on the prescribe radiation dose from our radiation oncology team.

Aug

Surviving Breast Cancer (Part 3)

By Provision CARES Proton Therapy

Casey’s Story: Starting Treatment

Casey is a two time breast cancer survivor who is sharing her experience during her proton therapy treatments at Provision CARES Proton Therapy Knoxville. Catch up on her story first by reading part one and part two of her blog series. As a Care Coordinator for Provision CARES Proton Therapy Knoxville and going through radiation therapy for the first time for recurring breast cancer, I can absolutely say that radiation therapists are gems…each and every one of them.

After initial office visits, CT Simulation, and treatment planning are finished it is time to start radiation therapy and these folks, the radiation therapists, are right there in the trenches with you. For the next 7 weeks I will see these wonderful people day in and day out to “finish off” this breast cancer.

Working at Provision gave me a sense of calm about the end result but to be candid, I was still nervous about the process. Would I know what to do and say? Is it weird to just lay on the table and be alone while radiation is being delivered? What does it feel like? Will I be self-conscious being exposed from the waist up?

Trust me when I tell you these therapists are experts at what they do. Zane, who manages the radiation therapists, was present for my first day. He explained everything to me as it was happening which was particularly helpful to me. A quick example: Zane explained body positioning, and how important it was to relax while being still. Proton therapy is very individualized which means no two plans are alike. Your plan is specific to your tumor size and site, your physical body size and contours and believe it or not, your breathing! These radiation oncologists and physicists think of everything.

After putting on a gown you are escorted to the treatment room and use a step stool to get on to a slightly raised table. In my case, radiation was going to be delivered with my arms above my head while I was lying flat with my knees slightly bent and supported. There is a mold for my arms to rest in that was made specifically for me. I remained covered up with a sheet until it was time for the actual treatment which was important to me. The next and maybe most appreciated step for me: MUSIC! It was calming and an immediate source of comfort for me. The therapists will ask you each day what you feel like listening to that day. This was a godsend to me as the music eased my nerves and passed the time.

I was unprepared for, but very impressed by, the perfection in positioning the therapists strive for. This is of utmost importance as the precise delivery (within a millimeter) of the proton beam depends on it. Before your actual treatment, one of our Radiation Oncologists will check the position of the patient and give the okay for proton delivery. The therapists leave the room and you are alone for about 90 seconds during treatment. You are never truly alone as you are being watched remotely, and after a few treatments you become very accustomed to the whole process.

Truthfully, it is a very quiet and calm time in the treatment room. There were no smells or sounds to really get used to and I did not “feel” the radiation delivery. For me, it was a time of reflection…a time to really think and appreciate what these fine folks do day in and day out. I never got the feeling that it wasjust a job for them. I always felt like I was the only patient there that day when in reality, there were up to 80 patients being treated in three treatment rooms.

Weekly visits with the clinical team are also part of your radiation therapy treatment. This is an important step in monitoring your skin and any other changes you may be going through such as fatigue. As I proceeded through treatment my only symptom was a significant “sunburn” to the areas treated. I was prepared for this and used creams and lotions that were suggested by my doctor. It was an easily forgotten side effect for me, though uncomfortable for a short period of time.

Every Friday I was given a treatment schedule for the next week. Wait, no weekends?.. a whole two days without radiation treatment? I wondered “What will I do without the conversations and encouragement from Amos, Chris, Jamie and Jennifer?” They were my people. My lifesavers. My friends. I can do this, and I will do this with the help of these compassionate, kind and relatable therapists.

To follow Casey’s story, please follow us on Facebook.

Jul

Surviving Breast Cancer (Part 2)

By Provision CARES Proton Therapy

Casey’s Story: Preparing for Treatment

Casey is a two time breast cancer survivor and care coordinator at Provision CARES Proton Therapy Knoxville. She answers phone calls and helps answer the questions of cancer patients every day, but with her experience on both sides of the phone, Casey is offering readers a unique perspective as someone who has been both a patient and someone who helps patients. To meet Casey, you can read part one of her blog series, Casey’s Story: Learning she has cancer for a second time

After all my tests and scans were complete, it was definite. Dr. Brig, my medical oncologist, told me I would have radiation therapy as part of my treatment protocol to make sure I never see this breast cancer again. My doctor knew that I know how important of a role proton therapy will play in my life with left sided breast cancer. Was I excited to undergo 34 radiation treatments? Not at all. Was I anxious about the possible side effects and time involved? I knew I would be tethered to Knoxville for the next 6.5 weeks, with only weekends off in between treatments. I mean, several months ago, I actually had a life! I regrouped and breathed a sigh of relief because I knew I would be in good hands at Provision.

A consult with one of our radiation oncologists is always the first step. A care coordinator that I have worked with for the past 2 years quickly gathered all my medical records and set me up to see Dr. Ben Wilkinson who spent time with me explaining how many fractions (treatments) of radiation I needed and how it may affect the skin around my left breast and axilla area, as well as my fatigue levels throughout treatment. He reassured me that he would be checking me weekly, right after one of my treatment days. Brittany, one of our awesome nurse practitioners, would also check my skin regularly. No stone would be unturned. If I needed anything, I knew who to ask.

Very shortly after consult I had what is called a CT Simulation. This is essentially a scan of your body to provide the contours needed for treatment planning. It took about an hour which was a bit longer than I expected in a slightly uncomfortable position with my arms above my head and lying flat on the table. Kerry, one of our incredible radiation therapists, made this procedure seamless for me. Not only is she an expert at what she does but she cares…and shows it in her disposition and heart-warming smile. A physicist, Sammie, was also present to help with body positioning and placement. We all know Sammie to be brilliant, energetic, beautiful and funny. She was one of many who would be making sure I never see breast cancer again.

After CT Simulation, I waited. I waited for these committed, hardworking, all knowing people behind closed doors of Provision Cares Proton Therapy to plan my treatment. They are a team of radiation oncologists, dosimetrists, physicists and radiation therapists. Not your average run of the mill people, but exceptionally trained and smart folks. All of whom are working on a treatment plan for me to be able to continue living my best life. It is truly humbling to me to be surrounded by such intelligence and excellence. It is fun too…. we laugh a lot at work and we appreciate each other. Not a bad gig for this girl. I love coming to work.

In the meantime, I patiently waited for my start date and appreciated all the hard work that brought me to this point in my interaction with Provision from a patient’s viewpoint. Many, many people got me to this point. The Finance/Insurance teams who work tirelessly to verify insurance benefits and fight for coverage….the Concierge team who coordinate countless appointments and make sure you as a patient are up to date on where you are supposed to be and what time….and our fabulous Hospitality team who treat you and your family members like guests in their home. What we call our “Culture of Care” is experienced in all facets of care at Provision. We know it is a hard time…a scary and challenging time, for many patients and their loved ones. We want our patients and their families to feel respected and cared for. I always smile when I peek downstairs at our lobby and see patients having coffee and chatting…after their treatment is finished. It is a beautiful thing. The next step for me? Starting my treatments.

To continue to follow my journey and read updated blog posts, please follow Provision on Facebook.

Jul

Upcoming Events: Prostate Cancer 101: Understanding the Journey Diagnosis, Treatment, and Survival

By Provision CARES Proton Therapy

Join us for a free presentation to learn more about the latest developments in prostate cancer. Dr. Wilkinson will discuss the most advanced diagnostic tools and current trends in treatment including multiparametric MRI, genomic classification, when to use active surveillance, and how to preserve quality of life after a prostate diagnosis.

Friday, July 26th from 930-11a and Friday August 23rd from 930-11a

Hosted by: Provision CARES Proton Therapy Knoxville, 6450 Provision CARES Way, Knoxville, TN 37909

RSVP: To reserve your seat, please RSVP to Jenni Turner at 865.321.4539 or jenni.turner@provisionhp.com

Jun

Proton therapy for treating left-sided breast cancer plays a crucial part in sparing damage to your heart.

By Provision CARES Proton Therapy

As with other cancers, the best possible outcomes for breast cancer treatment come through early breast cancer care. However, if breast cancer is diagnosed, treatments can include chemotherapy, hormone therapy, targeted therapy, surgery, and radiation. As there is not one perfect formula to eliminate the disease, many patients will need to undergo a combination of these treatment methods.

When it comes to radiation therapy, it is important to know your options and which type of radiation treatment is best for you.

Proton therapy is an advanced form of radiation therapy that is noninvasive and precisely targets your tumor using a single beam of high-energy protons to kill cancer cells. Proton therapy’s unique characteristics as a positively charged particle can precisely deposit radiation directly in the cancerous tumor with no exit dose. Both x-rays and protons damage cancer cells, but unlike standard radiation therapy, proton therapy deposits the majority of the radiation dose directly into the tumor. This spares nearby healthy tissues and organs from receiving unnecessary radiation, thus reducing damaging side effects and complications, compared to conventional radiation.

This is especially important in left-sided breast cancer, as the cancer is close to critical organs such as the heart and the lungs.

According to research published in JAMA Internal Medicine, women who have received breast cancer radiation treatment via x-rays face a 0.5% to 3.5% higher risk for heart attack or other cardiovascular issues. The risk is highest among women who’ve had conventional radiation to the left breast because of the target’s close proximity to the heart.

A European study in The New England Journal of Medicine revealed that the harmful cardiovascular effects typically begin to emerge as soon as five years after cancer radiation treatment.

With proton therapy treatment for breast cancer, on average, there is no radiation to the heart and 50% less radiation to the lung as compared with conventional radiation.

Furthermore, a 2014 clinical trial by Loma Linda University found that 90% of proton therapy cases result in “good: to “excellent” cosmetic result for partial breast radiation patients during the five years following treatment.

Proton therapy is extremely precise and therefore more effective at targeting cancerous cells without causing damage to surrounding breast tissue. Proton therapy is not a substitute for a lumpectomy and works with other modalities such as chemo-therapy and surgery. Rather, it is used as an alternative to conventional radiation therapy. After surgery a breast cancer patient may receive 2-6 weeks of proton therapy.

For left-sided breast cancer patients, this could be the key to a healthier life after treatment.

Jun

Surviving Breast Cancer (Part 1)

By Provision CARES Proton Therapy

Casey’s Story: Learning She Has Cancer for a Second Time

I have always considered myself a normal girl with a fairly normal life. Married to a great guy. I am healthy and active with 3 kids and a precious granddaughter who, along with my husband, are the loves of my life. We have lived in Knoxville for the past 18 years and feel blessed to have found this great part of East Tennessee to work, raise our kids and find wonderful friends. I have been working at Provision for two years now as a Care Coordinator, a position that I feel very comfortable with since I am a breast cancer survivor and can easily empathize with the patients. Recently, after two years at this job I love, I was again diagnosed with breast cancer. Although I have never blogged a day in my life, when presented with the opportunity to share my journey and my point of view from both sides of treatment, I thought it would be another way to help others facing cancer and radiation therapy – and for that reason, I was all in.

In 2012, while busy raising my then young teenagers, I was diagnosed with early stage breast cancer. My particular diagnosis required a bilateral mastectomy and reconstruction, and subsequent chemotherapy and immunotherapy. Relatively straightforward and at times challenging, but doable.

As a Care Coordinator, we are often the first person an individual who has been newly diagnosed with cancer or a concerned family member or friend speaks with when they call Provision CARES Proton Therapy for information. Almost always, this person is anxious, scared and uninformed about their illness. We do our very best here at Provision to provide a compassionate ear while collecting patient records and facilitating a consult date so that our radiation oncologists, clinical nursing and radiation therapy teams can address the patient’s treatment needs in a timely manner.

To hear for the second time in 6 years, “you have breast cancer” is enough to rock anyone’s world. I heard this news in the fall of 2018. Now, this mom of 3 children and one beautiful 6-year-old grandchild, was full of shock, fear and dread of what was in my immediate future: a whole lot of treatment that would NOT BE FUN and would cause me to again, lose my hair and my energy. And then maybe eventually… my life. We knew nothing at this point only that here we were AGAIN. It was a very dark time for my family. And for me.

Once the shock wore off, the Care Coordinator part of me began to surface. I knew immediately what I had to do to combat this disease for the second time. After a bilateral mastectomy and reconstruction in 2012, along with chemotherapy, I realized that radiation therapy would be in my immediate future. Recurrent breast cancer requires and arsenal of incredibly bright practitioners, along with state-of-the-art drugs and treatment. I knew right away that with left sided breast cancer, Proton Therapy is the recommended treatment in order to spare the heart and lungs from unnecessary radiation exposure. I knew that we (Provision) had a brilliant clinical team and a caring and conscientious support staff, state of the art technology and extensively trained radiation therapists.

This was not going to be a sprint…. but more of a marathon. As a former triathlete of 30+ years, I tend to think of things in segments or parts. Chemotherapy was the swim portion of the race. I hated getting in the pool, but knew I had to put the time in. Biking is fast and deliberate, and I related that to my surgery. Let the surgery be seamless and without complications (no bike wrecks). Get that cancer outta there! The last part of a triathlon is the running segment and I compare that to my upcoming radiation treatments. At this point you are tired and simply want a cold drink and some shade. But one must push on at this point and finish strong. Just like you surround yourself with training partners you trust and who make you feel good about your efforts, the same is true for your radiation treatment team.

I knew, without a doubt, that I would be well taken care of at Provision from start to finish. With all of this in mind, I also feel that everyone’s cancer journey is different. In this series of blogs, I’m sharing a little peek into my journey which I hope will give you or a loved one faced with a cancer diagnosis some peace of mind and maybe a smile along the way.

To continue to follow my journey and read updated blog posts, please follow Provision on Facebook.

Jun

New Study confirms proton therapy results in fewer side effects for many cancers.

By Provision CARES Proton Therapy

In the largest side-by-side comparison study of its kind, proton therapy was found to have fewer side effects while maintaining similar survival rates when compared to traditional X-ray radiation therapy.

The study, led by Washington University School of Medicine in St. Louis and the Perelman School of Medicine at the University of Pennsylvania, included almost 1,500 patients receiving combined chemotherapy and radiation therapy for lung, brain, head and neck, gastrointestinal and gynecologic cancers that were localized to one part of the body and had not metastasized. A combination treatment of chemotherapy and radiation therapy is a standard treatment leading to cure for many non-metastatic cancer. However, it is common for patients of this treatment regimen to experience severe side effects that can significantly reduce quality of life and in some cases require hospitalization, trading cure for side effects.

Proton Therapy is an advanced form of radiation therapy that uses protons to deliver the radiation directly to the tumor. Protons are positively charged particles that have a unique characteristic allowing more of the radiation dose to be directly deposited at the tumor. There is minimal entrance dose and no exit dose, significantly reducing radiation received to nearby healthy tissue and organs when compared to X-ray therapy that uses photons which travel all the way through the body and pass through healthy tissue on the way out. Both proton and X-ray radiation therapy are FDA approved.

According to the research, after controlling for differences between the groups, such as age and additional medical problems, the researchers found that patients receiving proton therapy experienced a two-thirds reduction in the relative risk of severe side effects within 90 days of treatment, compared with patients receiving X-ray radiation therapy. “We looked at grade-three side effects—including pain or difficulty swallowing, difficulty breathing, nausea, or diarrhea, among others—often severe enough for patients to be hospitalized,” says the study’s lead author Brian Baumann, an adjunct assistant professor of radiation oncology in the Perelman School of Medicine and an assistant professor of radiation oncology at Washington University School of Medicine in St. Louis. “Our clinical experience is that concurrent chemoradiation therapy patients treated with protons, rather than photons, tend to have fewer side effects. While there is some literature supporting that finding for several disease sites, we did not expect the magnitude of the benefit to be this large.”

Furthermore, the researchers found no difference between the two groups in survival, suggesting that proton therapy was just as effective in treating the cancer even as it caused fewer side effects. Overall survival at one year for the proton therapy group was 83 percent of patients versus 81 percent for the X-ray radiation therapy group.

To learn more about the benefits of proton therapy, visit our proton benefits page.

Source: Baumann BC, Mitra N, Harton JG, Xiao Y, Wojcieszynski AP, Gabriel PE, Zhong H, Geng H, Doucette A, Wei J, O’Dwyer PJ, Bekelman JE, Metz JM. Comparative effectiveness of proton therapy versus photon therapy as part of concurrent chemo-radiotherapy for locally advanced cancer. American Society of Clinical Oncology poster session. June 1, 2019.

May 8, 2019

Mason Strong: One teenage boys fight against pediatric brain cancer brings together an entire community.

No parent wants to hear that their child has cancer. Unfortunately, those were the words Ginger and Richard Cobble, parents of son Mason Cobble, 16, heard on Tuesday February 26, 2019. Mason is a sophomore at Walker Valley High School in Cleveland, TN and an overall healthy child. On Friday morning, February 22^nd of 2019, Mason had a seizure and was later diagnosed with Glioblastoma multiforme GBM, a rare brain cancer in children. He immediately had surgery to remove the tumor followed by proton therapy radiation at Provision CARES Proton Therapy Knoxville.

Proton therapy is an advanced form of radiation therapy that can be used in conjunction with pencil beam scanning technology. The combination allows radiation oncologists to precisely target the tumor, minimizing the dose of radiation received to nearby healthy tissues and organs. Because children and adolescents are growing, their tissue is more sensitive to radiation and its potential for negative side effects. 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). For Brain tumors, proton therapy can minimize negative side effects that include developmental delays, hearing loss, damage to salivary glands and hormone deficiencies.

A recent study presented at the European Society for Radiotherapy and Oncology Congress (ESTRO) compared three types of radiotherapy for pediatric brain tumors and found that in pediatric brain tumors, pencil beam scanning proton therapy consistently delivered the lowest amount of radiation to the hippocampus and temporal lobes, areas of the brain that are vital for memory function. Laura Toussaint, a PhD student in the Department of Medical Physics, presented the study and said, “alongside surgery and chemotherapy, radiotherapy plays an important role in treating brain tumors in children, but we need to protect children’s developing brains from unnecessary radiation. The more we learn about how to effectively target brain tumors while minimizing the dose to other parts of the brain, the better we can preserve children’s cognitive abilities and quality of life after treatment.”

After seeking the opinion of several medical professionals, Mason Cobble started proton therapy treatment at Provision CARES Proton Therapy Knoxville. In a post on the Team Mason Strong Facebook page, Mason’s mom Ginger Cobble said, “It is such a blessing that Provision Proton Radiation Therapy is in Knoxville. So thankful we get to treatment so close to home.” The Chattanooga and Cleveland Tennessee community has pulled together to support Mason in his fight against cancer. His story has been featured in the Cleveland Banner, on News Channel 9, on area radio stations and other media outlets.

On Wednesday May 8, 2019 Mason rang the bell as he graduated from his treatment at Provision CARES Proton Therapy Knoxville. He still has a fight ahead of him with more chemotherapy treatments and participation in a clinical trial at Duke, but the staff at Provision is thankful for him and are #TEAMMASONSTRONG.

May

Celebrating Nurses Week 2019

By Provision CARES Proton Therapy

Content and information were written in conjunction with Lindsay Chandler, RN, BSN, OCN Nursing Manager for Provision CARES Proton Therapy Knoxville

May 6^th-12th is a week of excellence for every nurse, and marks a time to acknowledge accomplishments, compassionate patient care and professionalism for the nursing society. The conclusion of Nurses Week is May 12^th, in honor of the mother of nursing, Florence Nightingale. Florence Nightingale was born on May 12^th, 1820, and she was the innovator of modern nursing. It was through her teaching, compassion, leadership and influence, that the world of nursing has evolved into what it is today.

2019 itself is a hallmark celebration for the nursing community. There are over 4 million Registered Nurses in the United States of America, and registered nurses comprise the largest group in healthcare! The American Nurses Association created the tagline for this year’s National Nurses Week is “4 Million Reasons to Celebrate” which is a nod to nurses’ sheer numbers and an open invitation to #ThankaNurse for enriching our lives and the world we live in.

May is also Oncology Nurse Month. As a cancer treatment facility featuring proton therapy, Provision CARES Proton Therapy Centers would also like to take a moment to highlight the role of the Oncology Nurse. Oncology Nurses care for people of all ages who are diagnosed with cancer. Oncology nurses provide support not only to patients, but their caregivers and families during an especially stressful time in their lives. An Oncology Nurse can gain knowledge through professional development and complete an examination to become an Oncology Certified Nurse (OCN). This certification signifies that a nurse has the knowledge and proficiency to care for patients with the diagnosis of cancer and marks a level of high achievement in the Oncology community.

Please join us in recognizing all the compassion and dedication our amazing nursing team provides at Provision Cares Proton Therapy Center. Our nursing team is responsible for documenting detailed health assessments for patients newly diagnosed with cancer, providing patient education founded on evidence-based practice, providing recommendations for screenings and follow up suggestions for abnormal values to ensure early intervention, administering medications, assisting in procedures, utilizing assessment skills and critical thinking to triage and identify acute or emergent conditions, participate in interdisciplinary team rounds to provide the highest quality of patient care.

Provision would like to acknowledge nurses throughout our country and how they influence and inspire as they practice their art of healing. Happy Nurses Week 2019!

Apr

Prostate Cancer 101: Understanding the Journey Diagnosis, Treatment, and Survival

By Provision CARES Proton Therapy

Thursday, May 9th at 6:30pm or Friday, May 17th at 9:30am

Hosted by: Provision CARES Proton Therapy Knoxville, 6450 Provision CARES Way, Knoxville, TN 37909

RSVP: To reserve your seat, please RSVP to Jenni Turner at 865.321.4539 or jenni.turner@provisionhp.com