Cancer care expanding; Local health care institutions plow money into new equipment and regional treatment centers.
WORCESTER - Central Massachusetts health systems are spending big money on cancer treatment facilities and equipment, an expansion that promises to push new services to additional sites and could help hospitals hold on to patients who might otherwise have gone elsewhere for treatment.
It's not exactly a medical arms race, but the expansions come at a time when hospital margins are under pressure and Massachusetts health systems are building out networks of doctors and facilities in preparation for possible changes in the way doctors and hospitals get paid.
The expansions range from a $12.7 million addition to the cancer treatment center at Marlboro Hospital, a community hospital in the UMass Memorial Health Care system, to the acquisition of CyberKnife radiation equipment, which can cost $3.5 million to $4 million, at St. Vincent Hospital in Worcester.
Doctors and administrators say they're responding to existing demand for cancer treatment by pushing more services out to smaller communities and beefing up their offerings with technology such as the CyberKnife system.
"That is creating an opportunity for keeping the patients within St. Vincent Hospital under the same care of their existing physicians," said Enzo Centofanti, executive director of the St. Vincent Hospital Center for Cancer Services.
Public health records suggest that the incidence of cancer is on the rise in Massachusetts, but the death rate is down, at least when measured over five years stretched from 2000 to 2008.
Meanwhile, cancer treatment alternatives in Central Massachusetts have grown. Milford Regional Medical Center opened a $25 million cancer center in Milford in 2008 with Boston's Dana-Farber/Brigham and Women's Cancer Center. A cancer center at Harrington Hospital in Southbridge opened in 2009, and Harrington and UMass Memorial launched a breast center there in 2010.
The Simonds-Sinon Regional Cancer Center in Fitchburg, part of UMass Memorial's HealthAlliance system, recently installed a new TrueBeam radiotherapy accelerator, a machine designed to deliver quick, precision-targeted radiation treatments to cancer patients.
Dr. Thomas J. FitzGerald, chairman of UMass Memorial's department of radiation oncology, said the need for advanced equipment is growing as new treatments develop and as different kinds of cancer emerge.
"We're now seeing glandular tumors of the esophagus. I never saw those as a resident," he said. "The diseases are changing in front of us."
Plans to expand cancer treatment at Marlboro Hospital, which already had expertise in breast cancer, began several years ago, according to Dr. Giles F. Whalen, chief of surgical oncology at UMass Memorial and interim director of the UMass Memorial Cancer Center of Excellence.
"The notion was that what we want to do as a system is to connect the cancer care that we develop, advance here, out to our member and affiliate hospitals, and we're all working off the same standards of care," Dr. Whalen said. "We feel that's going to put us in a better position to take care of populations of people."
UMass Memorial will transfer a state license for a linear accelerator, a type of targeted radiation therapy equipment, to Marlboro Hospital to put certain radiation services closer to patients in that area.
"When I have a patient who needs radiation, we always try to get it to them close to home," Dr. Whalen said.
At St. Vincent Hospital's cancer center, housed in leased space on Worcester's Summer Street, the new CyberKnife equipment sits in a room where workers have wittily embellished forest-motif wallpaper by cutting out pictures of birds and taping them to the wall. St. Vincent's lease on the space ends next year, and it will move cancer treatment operations downtown to a new $23 million facility.
Dr. Mark J. Brenner, director of the hospital's radiation oncology department, climbs onto a treatment table to demonstrate how patients would be positioned so the CyberKnife's robotic arm can rotate and shoot hundreds of pencil-thin beams of radiation onto the body to target tumors surgeons cannot remove. The typical candidate, he said, is a patient with lung cancer who cannot undergo surgery because of lung damage from smoking.
"There's a tremendous number of patients we see we have to say, `Listen, there's not a blessed thing we can do for this patient,'" Dr. Brenner said.
Massachusetts health care entities contemplating renovations, expansions or purchases of equipment such as radiotherapy accelerators typically must gain approval from the state's Public Health Council under a "determination of need" process.
When eight new licenses for radiotherapy accelerators opened up in 2006, UMass Memorial snagged one and used it for new TrueBeam equipment in Fitchburg, according to Dr. FitzGerald of UMass Memorial.
UMass Memorial also has ambitions to move cancer research trials and the cutting-edge medical treatments that come with those out to its regional hospitals. The system, which has 90 to 100 cancer studies open in Worcester, plans to base a research team part time at HealthAlliance Hospital - Burbank Campus in Fitchburg, according to Dr. Andrew M. Evens, UMass Memorial deputy director for clinical research.
"Not that HealthAlliance would have all of those (trials), but the ones that make the most sense for those patients and their population," Dr. Evens said.
Yet even as Worcester health systems purchase new equipment or push new services to area communities, the state is grappling with the cost of all that care. Policy makers are looking to change the way doctors and hospitals get paid by shifting from a fee for every procedure or visit to a bundled payment to cover all the care a patient needs. Some medical providers are experimenting with coordinated care by forming groups known as accountable care organizations.
The cost of diagnosing cancer and treating it with an ever-more sophisticated mix of radiation, surgery and chemotherapy is on the rise. A European panel convened last year by the British journal Lancet Oncology estimated that cancer diagnosis and treatment costs of $124 billion in the United States in 2010 could jump to $158 billion in 2020.
State legislators have been concerned about the state's process of licensing health care expansions and improving the efficiency of the state's health care system, according to state Sen. Richard T. Moore, D-Uxbridge, Senate chairman of the Legislature's Committee on Health Care Financing. He was not familiar with the Worcester hospitals' cancer treatment plans but said quality of care, access to care and cost are issues to address in health care expansions.
"It is certainly a concern to make sure if someone is expanding; does that improve the competition?" Mr. Moore said. "Is there a need for the service in the region where they're doing it?"
CUTLINE: (1) Dr. Mark J. Brenner, director of the radiation oncology department at St. Vincent Hospital in Worcester, stands next to new CyberKnife equipment that targets tumors with beams of radiation. (2) Collimators that are used with the CyberKnife system are shown.
PHOTOG: T&G Staff Photos/TOM RETTIG
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|Title Annotation:||BUSINESS MATTERS|
|Publication:||Telegram & Gazette (Worcester, MA)|
|Date:||Apr 15, 2012|
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