Many online blogs tell us the traditional 4th anniversary gift is flowers or fruit, but at Provision CARES Proton Therapy, we prefer cake! January 20th marks the 4th anniversary of operation for Provision CARES Proton Therapy Knoxville (PCPTK) providing the most innovative cancer treatment in the world, proton therapy.
The Lonas Family Legacy
“Many prayers were said over this land. That it would be used for something beneficial for our community and that it would be a blessing to all who visit…” Dowell Springs is a special place for many people in our community and visitors from near and far. Not only is the campus home to the Historic Lonas farmhouse, it is home to Provision CARES Proton Therapy. The beauty of the property and the magnificent views from the buildings bring a calm and healing atmosphere to all visit.
Dale Clayton first heard about Provision CARES Proton Therapy through a TV commercial. Not knowing he had cancer, he tucked the words “proton therapy” in the back of his mind, hoping that he would never have to remember them. It was February 2015 when Mr. Clayton learned he had prostate cancer. Dale had always been proactive when it came to his health. He said, “my mom always taught me to be proactive.” He went in for regular checkups, yearly physicals, and was well aware of his PSA and gleason score. At his appointment in 2015, all test scores came back normal, but he insisted on a biopsy, just to be sure. Both the doctor and Clayton were shocked, his biopsy came back positive. Dale was diagnosed with low risk, non-aggressive prostate cancer and decided on active surveillance.
Two and a half years later, things started to change. His PSA remained normal but his biopsy showed the cancer had doubled in size. “It’s a miracle we found it,” said Clayton, “I believe God placed the right doctors, urologists, and friends around me to help me make an informed treatment decision.” He researched prostate cancer and treatment options, from surgery to brachytherapy to protons, and there were two things that were very significant to his treatment decision process:
- Cure Rate
- Quality of Life
At Provision CARES Proton Therapy, we are dedicated to providing a safe workplace for our employees and a safe treatment environment for our patients. Just this month, our Provision CARES Cancer Center team in Knoxville received the official Accreditation Certificate issued by ASTRO (“Accreditation Certificate”). To receive this accreditation, the team was required to focus on five pillars of patient care. One of the five pillars of patient care is safety. The team demonstrated and committed to the highest standards of safety through daily processes and procedures. To read more about the Accreditation process and this achievement see our previous blog here.
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
After nearly two years of construction, Provision CARES Proton Therapy Nashville is nearing completion of its $100 million cancer-treatment center — minus some areas of the roof.
That’s because crews still need to lower a 28-foot-diameter gantry — a structure about the size of an above-ground pool that rotates around a patient during therapy, allowing treatment from different angles —into place at the 45,000-square-foot facility.
It will be the second center for Knoxville-based Provision CARES, which provides proton-radiation treatment for cancer patients. The Franklin campus will also include a 72,000-square-foot medical office building at the cost of $18 million. Both buildings are being funded by tax-exempt bonds issued by the Williamson County Industrial Development Board and are expected to be completed in the summer of 2018.
The gantry, however, is relatively light lifting over at the 11-acre site. In July, a 220-ton particle accelerator, almost the same weight as the Statue of Liberty, was delivered to the facility. Rod Manning, service and maintenance manager at Provision CARES subsidiary ProNova Solutions, said the massive piece of equipment, called a cyclotron, was lowered into place by a 440-ton crane, the largest in Tennessee.
“It’s like NASA landed in Franklin,” Manning said.
Proton therapy delivers a high dose of radiation through a beam and, according to Provision CARES Director of Medical Physics Marc Blakey, has fewer side effects than traditional X-ray radiation.
Blakey said he can plot exactly where cancer is in the body and attack it while sparing surrounding tissue.
“The beam enters and only goes as deep as the tumor. It doesn’t exit the body,” Blakey said. “This allows for a higher dose because we can avoid critical structures.”
The cyclotron acts as the engine in the process, producing beams of protons into one of three gantries enclosed with two-meter thick doors made of lead-reinforced concrete. Most treatments only last a few minutes; Blakey said the center could facilitate up to 90 patients a day.
The two-story building will also house work areas for Gilda’s Club of Tennessee and Scott Hamilton CARES Foundation. Hamilton is on the board at Provision CARES and will have an office at the center.
Tara Mullaney, vice president at Provision CARES, said the inside of the building is designed to feel like a hotel more than a medical facility. Each dressing room will be outfitted with TVs and will have their own themes. The waiting room will a kids play area and a large bell to be rung every time a patient completes the entirety of their treatment.
“Cancer patients are going through enough so we want to make them as comfortable as possible,” Mullaney said. “They are coming here every day so they get to know the staff and feel welcomed.”
Mullaney said that while proton treatment isn’t new — the first center opened in the 1990s — it’s still not widely known. She said that’s because the initial investment for equipment is so high and not all insurance plans cover the therapy, where treatment costs about $2,000 per visit.
The word, however, is spreading, Mullaney said. The Franklin facility will be the 26th proton-treatment center in the nation, up from 13 five years ago, and Provision CARES has plans to build three more centers, she said. Those will be in Orlando, New Orleans and China.
Mullaney said ProNova, a Provision subsidiary, is also designing ways to decrease the size of equipment, therefore making it less expensive to access proton treatment.
“We are always thinking of ways to get better,” Mullaney said. “Franklin costs considerably less than the center in Knoxville because of the reduction in size of equipment and smaller footprint.”
“It’s like NASA landed in Franklin:’ Proton-therapy center nears completion.” Joel Stinnett, Nashville Business Journal
When Hal Livergood came to Provision for treatment of his prostate cancer, 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.
“My doctor said, ‘You need to lose weight,’” Livergood says. Otherwise, treatment would not be an option.
CLICK HERE to watch the segment.
Nearly five years ago, 32-year-old Lindsay Rumberger was diagnosed with epithelioid hemangioendothelioma, a long name for a rare cancer that had originated in her liver and metastasized to her lungs. She underwent chemotherapy, but when a tumor close to her spine showed signs of growth, radiation was part of the recommended course. Because conventional radiation treatment threatened to cause peripheral damage to this most sensitive part of the body, her doctors recommended proton therapy instead. However, the insurance provider disagreed, calling the treatment “experimental” and refused coverage.
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.”
There’s a reason hospitality coordinator Sharon Bishop is a favorite with Provision patients: She’s walked in their shoes.
In 2006, Bishop was diagnosed with Stage 3 breast cancer.
Sharon has had a bi-lateral mastectomy, chemotherapy and conventional radiation—a treatment regimen that lasted five years. The chemotherapy caused cancer to develop in her uterus, requiring a radical hysterectomy. And the radiation left scars on her heart, requiring long-term follow-ups with specialists.
“Honestly, I’m never done,” Bishop says.
She was 42, with two teenage sons. And as she fought for her life, two sisters also were diagnosed with breast cancer.
Through it all, however, she maintained a positive spirit—joking with her sister about applying mascara to three remaining eyelashes so she could flirt with an officer should she get pulled over—and channeling her experience into a story of support she shared with others. Bishop has been involved with cancer support groups and had lots of one-on-one connection with cancer patients as a mastectomy fitter at Thompson Cancer Survival Center, the University of Tennessee Medical Center and Knoxville Comprehensive Breast Center. She also serves on the steering committee for the American Cancer Society’s “Making Strides Against Breast Cancer” initiative and is a member of the Young Survivors Coalition.
Bishop discovered Provision when her friend, Talbott Paynter, came to work here and encouraged her to apply. Her job lets her to get to know patients, offering a sympathetic ear and her own experience with cancer.
“When I started working here, I spent more time in the lobby than behind the desk,” she says.
Graduating patients get hugs from Bishop. Many confide in her their struggles and even medical issues they’re experiencing through the treatment. Patients often mention her when listing the things they appreciate about the Provision Center for Proton Therapy.
Her daily motivation comes from a picture on her bedroom dresser. It’s a black and white photo, snapped by her older son as she, hairless and weak, prays with her younger son in the midst of her battle with breast cancer. The image keeps her focused on why she comesto work here.
“Everyone that walks through that door, they matter to me,” she says. “I know what they’re going through.”