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Provision Center for Proton Therapy Archives - Provision CARES Proton Therapy Center

Nutrition plays important role in cancer treatment

By | Cancer, Culture of Care, Exercise & Nutrition, Prostate Cancer, Tennessee | No Comments

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. Read More

Dr. Oz spotlights need for insurance coverage

By | Cancer, Dr. Allen Meek, Insurance Coverage, Legislation, Patient Rights, Patient Stories, Uncategorized | No Comments

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. Read More

Provision patient has pre-treatment health makeover

By | Cancer, Culture of Care, Dr. Marcio Fagundes, Exercise & Nutrition, Prostate Cancer, Tennessee, Uncategorized | No Comments

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.”

Employee snapshot: Hospitality coordinator is a cancer survivor herself

By | Breast Cancer, Cancer, Culture of Care, Patient Experience, Patient Hospitality, Uncategorized | No Comments

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.

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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.”

Provision’s 400th patient not just a number

By | Cancer, Culture of Care, Dr. Marcio Fagundes, East Tennessee, Patient Experience, Patient Hospitality, Patient Stories, Prostate Cancer, Proton Therapy, Uncategorized | No Comments

James Fulghum’s completion of prostate cancer treatment today was a celebration not only for him but for Provision Center for Proton Therapy as well—the graduation of its 400th patient.

A surprised grin crossed Fulghum’s face as he was presented him with a special certificate before he rang the graduation bell.

The event marks a “huge milestone” for Provision. The center opened last January and celebrated its 100th patient graduation just eight months ago. Since then, Provision Center for Proton Therapy has opened a third treatment room and seen its patient numbers increase significantly in 2015.

Fulghum, who came for treatment for aggressive prostate cancer from his home in Lebanon, Tenn., learned of proton therapy through his nephew. Founder and principal at civil engineering firm, Fulghum, MacIndoe & Associates, Billy Fulghum worked with Provision in its early days as the company made site design plans for the new treatment facility.

When his uncle was diagnosed with cancer, Billy Fulghum approached him about considering proton therapy as a treatment option.

“The first thing he said was, ‘I’m not going to the Bahamas to do some experimental thing,’” Billy Fulghum said.

But after perusing the Provision website and meeting with Dr. Marcio Fagundes and staff at Provision, James Fulghum was sold.

“(Dr. Fagundes has) been in this business for many years. He’s seen a lot of things,” Fulghum said. “He laid it out in simple terms that I could understand.”

At the end of eight weeks in Knoxville golfing, visiting the mountains, making friends with other patients—two of whom attended his graduation—and experiencing the hospitality and warmth of the Provision employees—from radiation therapists to hospitality coordinators to financial services manager Rhonda Turner—James Fulghum said he’s sad to go.

“I feel like when I walked through the front door this was heaven and these people were angels,” he said. “Even though I’m number 400, I’m not a number in this place.”

 

Provision employee’s invention makes headlines, benefits patients

By | Cancer, Innovation, Patient Experience, Proton Therapy, Uncategorized | No Comments

When radiaton therapist Zach Dutton got tired of cobbling together boxes and construction foam from Lowe’s to assist in making the cradle that holds patients immobile during their proton therapy treatments, he decided to solve the problem himself. With the help of his dad, Greg Dutton, he came up with the Z-box, an innovative frame that holds patients in place while their foam cradles are being poured and solidified around them.

The invention has garnered Dutton local headlines in the Knoxville News Sentinel and Loudon County News-Herald (the Duttons are from Lenoir City) as well as a byline in the Spring issue of the medical journal Radiation Therapist. First prototyping the box in plywood, the father-and-son team then crafted a plastic version of the Z-box that patients now regularly use.

The adjustable frame accommodates patients of varying flexibility—they must hold their arms above their heads during the process—and makes it possible for one technician to carry out the process. Prior to the Z-box, at least two people were needed to help hold the patient in place. As a result, what was once a one-and-a-half to two hour process in making the patient cradles, has been whittled down to 30-45 minutes.

While the device works well for proton therapy patients, it also could be used for conventional radiation therapy in cases where the patient needs to be kept still during treatment.

What motivated Dutton to take on the project? “I’ve always thought we could make things better,” he says.

Proton therapy showcased on Ellen

By | Cancer, Pediatric Cancer, Proton Therapy, Sarcoma, Uncategorized | No Comments

Julie Kramer, famous for her appearance on The Ellen DeGeneres Show last year after being diagnosed with stage 4 synovial sarcoma, returned to the show this week. There she announced she was cancer free following proton therapy treatment. Proton therapy is an ideal treatment option for sarcoma because, when using traditional radiation, the location of these cancers often results in undesirable side effects to important organs such as brain, heart and lungs. Provision Center for Proton Therapy offers proton therapy treatments for both adults and children.

Patient Story: Kimberly Krause

By | Breast Cancer, Cancer, Clinical Care, Dowell Springs, Dr. Allen Meek, Patient Experience, Patient Stories, Proton Therapy, Uncategorized | No Comments

Kimberly Krause is the first breast cancer patient to complete treatment at Provision Center for Proton Therapy.  She shared her proton therapy journey with the Shopper News.

Kimberly Krause is an energetic woman with a fast-paced job managing a restaurant. But, when she was diagnosed with breast cancer last year, the Provision Center for Proton Therapy helped keep her on her feet through treatment.

With a grandmother and two aunts diagnosed with breast cancer, Krause started yearly mammograms early. At age 39, her mammogram showed a possibility of breast cancer, and she went in for a biopsy Dec. 18. She was out of town on Dec. 20, when her doctor called with the news. She had breast cancer in the early stages, and six weeks of radiation, plus a lumpectomy or mastectomy was recommended.

Krause is a patient at Knoxville Comprehensive Breast Center, on the same campus as the Provision Center for Proton Therapy at Dowell Springs. Her surgeon for the lumpectomy was Dr. George Webber. Each morning, a multi-disciplinary task force, including pathologists, oncologists, surgeons, radiation therapists and more, meet to review patients and recommend the best course of action for each patient.

“We all meet in order to provide input into a patient’s case so they can get the best possible recommendations,” said Webber.

Included on that task force is Dr. Allen Meek, board-certified radiation oncologist and Medical Director of Provision Medical Group. Because of the placement of Krause’s tumor, traditional radiation could have affected her lungs, giving her a higher chance of developing lung cancer later in life.

“This is not an immediate effect,” said Meek. “What can happen is potential long-term radiation damage to the left side of the chest. This includes a higher incidence of heart disease and a higher incidence of lung cancer. Proton therapy is certainly advantageous for younger women. Many chemotherapy drugs can potentially affect the heart, also.”

The proton beam can be controlled to send as little radiation as possible to nearby organs. Meek said another concern with traditional therapies is the chance of radiation scattering to the opposite breast.

“The benefit in my view is that we get the same benefit for the breast, and we reduce by a considerable margin the damage to the heart and lung,” said Webber. “The less we irradiate the internal organs, the better it is for the patient, period.”

“People need to know that side effects from protons are similar to traditional radiation: sunburn-like irritation at the site, fatigue, sore throat,” said Meek. “But most of our patients can keep working right through that. They have noticed some fatigue but bounce back quicker.”

Krause started treatment at Provision in early 2014, soon after the center opened.

“It was amazing. I had minimal side effects and was able to keep the same work schedule,” she said.

Krause is the first breast cancer patient to complete treatment at the Provision Center for Proton Therapy. She has been cleared and has a follow-up appointment scheduled for December.

“Everybody here was so nice,” she said. “They are very caring and wonderful people. I would suggest this 1,000 times over traditional radiation. “I got very lucky. It could have been way worse.”

Dr. Matt Ladra Discusses Proton Therapy and Pediatric Cancer

By | Dr. Matt Ladra, Pediatric Cancer, Proton Therapy, Technology, Uncategorized | No Comments

WVLT’s Kelli Parker interviews Provision Center for Proton Therapy’s Dr. Matt Ladra, Director of Pediatric Services, about the benefit of proton therapy for certain types of childhood cancers.

Proton therapy has been used for more than 30 years to treat children.  Proton therapy is most commonly used in pediatric tumors of the brain and spine, such as medulloblastoma, ependymoma, germ cell tumors, and low grade gliomas, but it can be beneficial in any tumor that arises in close proximity to vital structures like the heart, lung, kidneys, and reproductive organs.  The Provision Center for Proton Therapy is the first proton center to open in Tennessee and will join the University of Florida Proton Institute as the only two centers in the southeast treating pediatric patients.

ASTRO Releases Proton Therapy Insurance Coverage Policy

By | Clinical Care, Patient Experience, Patient Stories, Proton Therapy, Uncategorized | No Comments

The premier radiation oncology society in the world, the American Society for Radiation Oncologists (ASTRO), has issued a new Model Policy for proton beam therapy (PBT) that details which cancer diagnoses meet ASTRO’s evidence-based standards and should be covered by private insurers and Medicare.  This is a very significant and welcome development that will help us gain insurance coverage for patients that require proton therapy.

All patients at the Provision Center for Proton Therapy are registered on a multi-institutional registry.  ASTRO stated in their new policy “All indications are suitable for Coverage with Evidence Development (CED).  Proton therapy patients should be covered by the insurance carrier as long as the patient is enrolled in either an IRB-approved clinical trial or in a multi-institutional patient registry.  At this time, no indications are deemed inappropriate for CED.”

Developed by leading radiation oncologists and medical physicists, including significant input from expert representatives in proton therapy, this Model Policy supports PBT coverage for appropriate patients and identifies areas where coverage with evidence development and further research are needed.  ASTRO Model Policies are developed to communicate what ASTRO believes are correct insurance coverage policies for radiation oncology.

ASTRO went on to state:  PBT is neither a new nor an experimental technology for treating cancer with radiation. It utilizes proton radiation particles to deliver highly conformal radiation therapy to a specific tumor target area while giving a much lower dose to the normal tissues in the proton beam’s path of entry and exit. PBT’s reduced radiation dose to healthy tissues is attractive because it can reduce side effects for patients, which potentially increases their quality of life.

“Proton beam therapy (PBT) is demonstrating promise in our continuing efforts to improve survival and cure rates for cancer patients while reducing side effects,” said Colleen A.F. Lawton, MD, FASTRO, chair of ASTRO’s Board of Directors. “As the leading experts in radiation oncology, it is important for ASTRO to provide balanced, evidence-based guidance to payers that ensures access to PBT for cancer patients while being judicious stewards of our nation’s and our patients’ financial resources.”

This Model Policy recommends two coverage groups for PBT: 1) patients with specific diagnoses for which PBT has been proven to be effective; and 2) patients with cancer diagnoses where evidence of effectiveness of PBT is still emerging, and therefore coverage with evidence development is recommended for patients if they are enrolled in clinical trials or a multi-institutional registry to collect data and inform consensus on the role of proton therapy.

ASTRO Model Policies are developed to communicate what ASTRO believes are correct coverage policies for radiation oncology. The ASTRO Model Policies do not serve as clinical guidelines, and they are subject to periodic review and revision. The ASTRO Model Policies may be reproduced and distributed, without modification, for noncommercial purposes. ASTRO has previously issued Model Policies on coverage for brachytherapy, intensity modulated radiation therapy (IMRT), stereotactic body radiation therapy (SBRT) and stereotactic radiosurgery (SRS), and they are available online at www.astro.org/Daily-Practice/Reimbursement/Model-Policies/Model-Policies/.

The PBT Model Policy was approved by ASTRO’s Board of Directors on May 20, 2014, and is available online at www.astro.org/.

ASTRO is the premier radiation oncology society in the world, with more than 10,000 members who are physicians, nurses, biologists, physicists, radiation therapists, dosimetrists and other health care professionals that specialize in treating patients with radiation therapies. As the leading organization in radiation oncology, the Society is dedicated to improving patient care through professional education and training, support for clinical practice and health policy standards, advancement of science and research, and advocacy.