Q&A: 1 vs. 2 cancer centers

Central DuPage Hospital is expected to learn today whether it can build a revolutionary proton therapy cancer treatment center in Warrenville. Only five such facilities exist in the nation.

Among those awaiting the outcome of the decision by the Illinois Health Facilities Planning Board are officials with Northern Illinois University, which is building its own proton therapy center at the DuPage National Technology Park in West Chicago.

NIU is opposed to the Central DuPage project. In fact, both sides can't even agree on how far their centers would be from one another.

John Lewis, executive director of the Northern Illinois Proton Therapy Treatment and Research Center, says Central DuPage would duplicate services just six miles from the university's center.

Jim Spear, executive vice president of the Winfield hospital, points out that its proposed $140 million proton center would be nine "driving miles" from the $159 million facility that NIU is building.

Now it's up to state regulators, who already have approved NIU's project, to determine whether the Chicago area can support two proton treatment centers. At their peak, each center would be capable of treating up to 1,500 patients a year.

Recently, the Daily Herald spoke with Lewis and Kathy Buettner, NIU's vice president of external affairs, about why they believe the university's center, scheduled to open in February 2010, shouldn't have competition. In a separate interview, Spear discussed why there should be two such centers.

Here are the edited responses from both interviews:

Q. Why do you want to do this project?

Spear: We're in the business of taking care of patients. And 27 percent of the people who have cancer in DuPage County leave the county for treatment. Our job at Central DuPage Hospital is to provide treatment where people live.

Proton therapy is an advanced form of delivering radiation as part of the treatment of cancer. That's something that we think we do very well ­- applying technology to patient treatments.

Lewis: The primary purpose is patient care. The second major thrust would be research - the third is education.

It makes sense for us to say, "If we're going to do this, we're going to do it comprehensively." We are going to do the training and the education component in an academic setting, perhaps partnering with other centers as well.

It does make our center unique from others being planned around the country.

Q. Why can't two centers exist within 10 miles of each other?

Lewis: It's our very strong conviction that at this point in time - given the state of the industry, given the reimbursement patterns, given the current research that's being done - we really feel that now is the time for only one center.

You've got very high capital costs going in. And in order to recover those capital costs, given the demand, you almost need a monopoly to begin with. As the market grows, as people learn more about proton therapy, as referral patterns get put into place, five, 10 years down the road, there's certainly potential for another center.

Spear: Wouldn't you like to be the only newspaper in town for two years, five years, 15 years?

I don't understand that. There is so much demand. All this political stuff I don't care about. For every month that there isn't a center in our market, there's 125 patients that don't get treated.

We want to bring this to Chicago. This is what we do. We bring state-of-the-art technology to medical care.

Q. How many cancer patients could benefit from proton therapy?

Spear: There are 60,000 new cancer patients every year in the state of Illinois. We believe about 10,000 to 11,000 could benefit from proton therapy.

Lewis: There are 80,000 to 90,000 new cancer patients a year within a 250-mile radius of Chicago.

About 20 percent of the (estimated 40,000) patients eligible for radiation therapy would be prime candidates for protons. So now you are down to 8,000. If you can attract 20 percent of that market to actually walk through the door, you are down to 1,600.

Q. Is 1,600 patients the most this market can handle?

Spear: I think that number is low. Just using the math in Illinois - 10,000 to 11,000 (patients eligible for proton therapy) is way in excess of the capacity of the two facilities.

One of our partners (Radiation Oncology Consultants Ltd.) is the largest group of radiation oncologists in the state of Illinois. Their patients alone will fill up 75 percent of the capacity of our center.

So do I think 3,000 is attainable? Easily. I don't think Northern is going to have any problem filling up their center with our center here, too.

Q. What about patients' ability to pay?

Buettner: Unfortunately, we don't make those decisions. Medicare makes those decisions. The insurance companies make those decisions.

If you check around with the centers that are open, you'll find that over 90 percent of the patients who try to come through their door have to go through an appeal with their insurance company to even be covered.

It's not simple enough to think that we can just open the door and they will flood in, because there aren't enough people in the country who can afford this kind of therapy without, obviously, having it blessed by Medicare or by Medicaid or their insurance company. And that's really the bottom line.

Spear: If a patient's insurance covers it, then we'll take the reimbursement from the insurance company. If it's a question of they can't pay, we're not going to deny care. We have financial assistance programs. We have charity care policies.

So the ability of the patient to pay is not the issue for us. The issue for us is providing effective radiation care for our patients.

Q. If Central DuPage's application is approved, what happens next?

Lewis: My guess would be, if the second center is approved, five years from now, we will, at best, see one - and maybe none. The argument that we need two centers, from my perspective, is a weak argument.

Spear: We have financing from a leading bank, and they did a whole lot of due diligence about whether there's sufficient demand. That financing was signed up in March 2008. What happened in February? Northern was approved. The bank knew that Northern was out there. But they knew that the demand was so strong that doesn't matter.

Q. What happens if Central DuPage's application is denied?

Spear: Under the rules and regulations of the health and planning board, you have to wait a year before you can reapply for that project.

We're going to wait. We're not going away. There are cancer patients that need proton beam therapy. And we are committed to delivering that treatment, that therapy, for our patients.

Q. How does NIU respond to the argument that there are patients who can't wait for a second center?

Lewis: You really need to look at this as an investment decision and what's best for the state of Illinois in the long run ­- not from an emotional perspective. And it's really tough to take the emotion out of it when you are talking about kids having access and cancer deaths and so forth. It's really easy to play on the heartstrings.

But if you take a look at it as a pure and simple investment decision, what's the right decision going forward? What's going to be right for the state of Illinois in the long run? We're convinced that at this point in time it's one facility.

What is proton therapy?

It's an advanced form of radiation therapy that uses proton beams to treat a variety of cancers.

Like traditional radiation therapy, proton therapy kills cancer by preventing the cells from growing and dividing. But because the proton beam can be specifically targeted at the tumor, higher, more effective doses can be delivered while causing less damage to healthy tissue.

The types of cancers that can be treated with proton therapy include prostate, colon, head, neck and brain tumors.