Why Proton Therapy Centers Are Here to Stay

With the announcement of a new contract for Ion Beam Applications to install proton therapy systems in Arkansas and Albuquerque, some industry insiders are revising their thoughts on this cancer treatment’s potential. Widely perceived as being on the decline, proton therapy centers have quietly been growing in popularity. Why?

What are proton therapy centers?

Proton beam therapy is radiation to the body to treat cancer—but it’s unique from other radiation therapies because it uses protons to target tumors, rather than X-rays. Facilities typically include a synchrotron or cyclotron machine to speed up protons and harness their energy into a radiation beam that targets cancerous cells. It offers a medical advantage over X-ray treatment because it targets cancerous cells more precisely, using a lower dose of radiation and minimizing side effects and harm to healthy cells.

Why do some believe proton therapy centers are on the decline? 

Despite their medical benefits for patients, some proton therapy treatment centers have struggled financially and filed for Chapter 11 bankruptcy. This is due in part to enormous capital startup costs, and in part to insurance companies’ reluctance to reimburse for the new radiation treatment: one lobbying group found that 63% of oncologists’ requests for proton therapy were denied by their patients’ insurers.

Proton centers are more financially sustainable than they seem

Proton therapy centers’ liabilities are well known, but facilities and manufacturers still perceive them as a sound investment, and this explains their increasing popularity. New proton centers outnumber those filing for bankruptcy, and most of those that file for bankruptcy restructure rather than close their doors. It is true that the reimbursement system for proton radiation therapy does not make for a quick return on facilities’ investment, given the high startup costs of the centers. However, OEMs seem willing to accept the risk of selling these machines to clinics that may default on their payments after failing to recoup their investment quickly enough. Their bullish attitude may be due to the rise of lobbying groups that are advocating for increased reimbursement for proton treatment, as well as aggressive marketing efforts by cooperative groups and OEMs themselves to increase awareness of proton therapy’s benefits.

Another reason for proton centers’ popularity is the ongoing diversification of the facilities that are investing in them, meaning an increase in the potential market size. Large proton beam therapy systems, like IBA’s new facilities in New Mexico and Arkansas, will undoubtedly continue to open around the country. However, it’s also likely that larger hospital networks will incorporate more single or dual gantry proton therapy centers into their radiation oncology arsenals. And as technology evolves and proton machines become smaller, facilities with limited space and budget will also become more open to purchasing these systems.

All of this optimism has led to the rise of secondary businesses focused on proton therapies, from finance and investment companies to consulting and management firms. These include:

• American Shared Hospital Services
• Legion Healthcare partners
• Proton International
• Proton Therapy Partners (part of Concord Health Partners portfolio)
• SAH Global

Law firms have even begun to specialize in securing reimbursement from insurance companies for proton therapy treatment claims.

Proton therapy centers by the numbers

Working Proton Treatment Facilities in the United States

2010: 6

2022: 41

2023 (estimated): 46

Internationally, there are another 72 sites and an additional 36 are under construction, with another 31 in the planning stages and expected to be completed around 2024. A wide variety of companies are currently manufacturing proton therapy treatment equipment, and even more are considering entering the market. These include:

• Advanced Oncotherapy
• Advanced Proton Solutions
• Bdotmedica
• Best Particle Therapy
• Hitachi
• IBA
• Mevion
• Mitsubishi
• Optivus Proton Therapy
• ProNova Solutions
• ProTom International
• Sumitomo
• Toshiba
• Varian

While some of these organizations’ efforts are very early in the development stages and don’t have FDA approval, the keen interest by many key players in the radiation oncology industry indicates one thing: Individual proton therapy centers may be struggling, but the industry as a whole is not going anywhere.