Getting proton therapy treatment

Your care team is committed to continuously improving and raising the standard of care. We will help you with your medical needs and assist you as you prepare for your daily treatment session:

Care team nurses will provide day-to-day care and help coordinate any additional medical services you might need during your proton treatment, including: arranging for blood tests, scans, medical appointments or other services you need. Your clinical nurse is a registered nurse with experience in radiation therapy.

Radiation therapists will ensure you are positioned comfortably and aligned correctly. They will deliver your daily treatment and will remain close by while you receive therapy.

Your radiation oncologist is your doctor and will meet with you once a week to review your progress and discuss any questions or concerns you may have. The radiation oncologists who provide proton therapy Fred Hutch are all members of the University of Washington Physician Group and hold faculty positions within the UW School of Medicine.

Your care team is dedicated to your ongoing care and will remain in contact with you and your primary physician after you’ve completed treatment.

In addition to your personal care team, there are many others on staff to support you during your time at the Proton Therapy Center:

Patient care coordinators coordinate the exchange of records, collect information for evaluating your individual case, and schedule your consultation. They also assist you with insurance, Medicare or Medicaid coverage.

Child life services focuses on the emotional support of children in treatment. A child life specialist is a skilled and caring pediatric health care professional who helps you and your child understand proton therapy by using language and visual aids they understand. They also teach methods to help young patients relax, express their feelings, and understand medical procedures.

Patient navigator/concierge team greets you and your loved ones when you arrive and can help answer questions and address your non-medical needs. They help you with your special personal needs. For patients traveling to Seattle for treatment, our Concierge Team can assist with transportation, lodging, and services in the area. They will also plan and coordinate special educational and social programs to enhance your stay.

Treatment coordinators coordinate your CT Simulation appointment, treatment schedule, and weekly visits with your radiation oncologist.

Medical physicists assure the safe and effective delivery of radiation by monitoring the equipment and procedures used in therapy. They run patient-specific checks on the plan created especially for your treatment to be sure you receive the correct dose of protons targeted precisely to your tumor.

Medical dosimetrists collaborate with your doctor to prepare a treatment plan specific to you. They calculate the angles and doses of proton energy required to treat your tumor, while ensuring your healthy tissue is exposed to as little radiation as possible. They will work closely with the radiation therapists throughout your course of treatment.

Machinists create custom treatment devices that are used for certain patients.

Engineers monitor and ensure the system and equipment output is precise.

Administrative staff provides management of office and business functions and helps manage your insurance claims.

Facilities staff maintains the building and ensures it is clean and safe for our patients.

Collecting your medical information

Your specific diagnosis and other factors will help determine if you could benefit from proton therapy. When you call, the patient care coordinator will ask you several questions regarding your medical history. Our team will assist you in collecting the following documents and information before presenting your case to the physician review board for evaluation:

Your cancer diagnosis

• Imaging or diagnostic records from your physician
• Any prior cancer treatment you may have had
• Pathology reports
• Your current medications
• Family medical history
• Insurance information
• Availability for treatment
• A referral for radiation therapy

Medical review process

A physician review board will evaluate your diagnosis in detail to determine if you may benefit from proton therapy. Once your diagnosis has been reviewed, you will be contacted to discuss the next steps. If it is determined that your diagnosis is not appropriate for protons, other treatment options will be recommended.

Securing coverage

During the medical review process, your patient care coordinator will contact your insurance carrier to determine your plan's coverage. They will also help you understand your potential costs. Most private insurance plans, Medicare, and in many cases, Medicaid, cover proton therapy. If your insurance doesn't cover all of your expenses, your patient care coordinator will help you find alternative financing options.

Our process is designed around minimizing your stress and preparing you for what’s to come. At your in-person consultation, you will meet with your doctor and nurse to discuss your treatment plan. The nurse assigned to you will be a member of your care team. Your care team also includes your radiation therapists. This team of individuals will stay with you throughout your entire course of treatment and remain involved during your follow-up care. Having the same team of individuals throughout therapy ensures consistency of care.

Treatment planning

After you’ve had your consultation and any additional tests you may need, you will be scheduled to come to the center for a computed tomography simulation (CT) scan. You can expect your appointment to take up to two hours, including preparation time. Your nurse will also use this time to educate you about the treatment process. The CT images are used by your medical team to create a personalized treatment plan specifically for you. The treatment plan will provide important details, including the exact dose of protons you need to target your tumor with precision.

Scheduling your therapy sessions

Once your personal treatment plan is complete, a radiation therapist from your Care Team will contact you. He or she will tell you how many treatments your doctor has prescribed and schedule your first appointment for proton therapy. Most patients are scheduled for therapy five days a week, excluding weekends and holidays, for a period of four to eight weeks. Your schedule will depend on your diagnosis and the best approach to deliver proton therapy for your precise needs.

Proton Therapy Clinical Trials at Fred Hutch 

Since proton therapy was approved by the U.S. Food and Drug Administration to treat patients in 1988, the medical community has continued to conduct research on the use of protons in treating different types of cancer through clinical trials. Over the years, many patients have volunteered to take part in these clinical trials to help find improvements in fighting cancer with proton therapy.

As a provider of proton therapy, Fred Hutch is always looking for ways to improve the lives of patients with cancer. Please ask your doctor during the in-person consultation for more information if you are interested in clinical trials.

Learn more about proton therapy clinical trials

During your consultation, your doctor may decide additional tests are necessary to plan your treatment, such as blood work, magnetic resonance imaging (MRI), or positron emission tomography (PET) scans. Your care team nurse will help you coordinate and schedule any tests. If you do not have a local primary doctor, your nurse will make sure you get all the additional services and therapies you need.

Treatment planning

After your consultation and any additional tests, we will schedule you for a computed tomography (CT) scan at the Proton Therapy Center. This will take up to two hours, including preparation time. Your nurse also will use this time to help you understand the treatment process.

You may have had a CT scan in the past to diagnose your tumor or for another medical reason, but this particular CT scan is necessary to gather images of your tumor and normal tissue from many angles so your doctor and other scientists can perform treatment simulation and planning.

We use these images to create a treatment plan specifically for you, with details on the exact dose of protons you need precisely targeted to your tumor. Depending on the location of your tumor, you may receive a contrast agent, or dye, before your CT scan so the tumor is easier to see. The dye may be injected through an intravenous (IV) line, taken orally, or administered through a catheter.

A radiation therapist will guide you through your CT scan (also referred to as “CT Simulation”). During your appointment, the radiation therapist will work closely with you to create an accurate and reproducible treatment position specific to your individual needs. This is achieved by use of special immobilization devices such as: masks, leg molds, headrests, sponges, and pillows. Many of the devices that are used are customizable and made just for you to ensure that you receive an accurate treatment.

Using your CT images, a team of proton therapy experts will develop an individual treatment plan for you, determining the number of treatments you need and the best technology for your care.

The machinists will create custom devices, including brass apertures and wax compensators in the shape of your tumor. Many times your care team will use multiple devices, depending on the location and complexity of your tumor. The devices are attached to the nozzle of the machine that delivers the proton beam. They shape the beam to the precise shape and depth of your tumor.

Scheduling your treatment sessions

Once planning for your cancer treatment is completed, someone from your care team will tell you how many treatments are prescribed and schedule your first appointment. Most patients have therapy five days a week (excluding weekends and holidays) for 4 to 9 weeks, depending on the total number needed. Occasionally your doctor may order additional treatments or breaks in your regular treatment schedule. You will always be informed of any changes.

You will be told when to arrive for your first appointment and you will be provided with any special instructions (for example, some patients need to come with full or empty bladder, or need to avoid wearing deodorant or lotions). At the end of each treatment week, you will get your schedule for the following week. You will need to come to the proton therapy facility approximately 10 minutes early to complete any necessary preparations, such as changing into a gown and consuming specific amounts of fluid.

While we make every effort to schedule your appointments based on your preference, we aren’t always able to for a variety of reasons. For instance, pediatric patients aren’t allowed to eat or drink before treatments so we save early morning appointments for them. We appreciate your understanding and flexibility.

Arriving for your treatment sessions

When you arrive for your treatment, you’ll be greeted by a member of your care team. You may be asked to change into a gown, robe and slippers provided by the care team. There are secure lockers for you to store your clothing or other personal belongings. If necessary, the care team will ask you to drink a specific amount of fluid shortly before your treatment.

During your treatment sessions

Most patients do not feel pain or discomfort during proton therapy treatments. Members of your personal care team will assist you throughout the process.

You will lie on a treatment bed and your therapists will make adjustments. Since proton therapy is precise, your treatment set-up must be very accurate. This is why we use the immobilization devices. You will be asked to lie still during the process and while the proton beam is on, which usually is about one minute. The care team will determine your proper positioning and you will be automatically moved into position before each treatment using an FDA-approved robotic positioning system.

During the actual treatment you will not feel or see the proton beam. You may hear some clicking from the equipment around you, but generally after a few treatment sessions the sounds go unnoticed. Your radiation therapists will need to leave the room at that time, but they watch you through a video monitor. They remain close by and can easily talk to you. The entire session will take about 30 minutes. No recovery time is needed, and you may immediately return to your normal daily activities. There is no need to stay overnight in a hospital or remain at our proton therapy facility after your treatment.

Few side effects

Typically, there are no or few side effects from proton therapy. If there are side effects during or after treatment, they are generally minor and occur after a number of treatments. Depending on the site of your tumor, side effects may include skin irritation in the direct path of the proton radiation, tiredness, and hair loss in the area being treated. Before treatment begins, your doctor will discuss with you any possible side effects. Your Care Team nurse will help you manage any side effects you may have.

Meeting with your doctor or staff at our proton therapy facility 

Once a week (or every five treatments), you will have a meeting, called an on treatment visit (OTV), with your radiation oncologist to discuss how your therapy is going. This is a good time to ask any questions you may have. In some cases, your doctor may order additional tests such as blood tests, CTs, MRIs or other scans. Your OTVs with your doctor are scheduled around treatment sessions, so there is no need to make an extra trip to the Proton Center.

Bring a loved one

We know how important it is to have the presence and support of those close to you. We encourage you to bring one loved one with you to your appointment if you can.

Traveling to Seattle for treatment

Seattle welcomes patients and their families to our city during treatment. Our proton therapy facility has a concierge available to assist with all of your needs -- from accommodations with negotiated rates to transportation to suggestions on exploring the city.

Radio-Frequency Identification (RFID)

The purpose of the system is to monitor patient location to provide data on factors such as waiting times and treatment times. The system allows the proton therapy staff to monitor the time of the treatment phase, from the point the patient enters and exits the building. This will assist us with identifying and trending data for our continuous commitment to providing our patients with the quality of care they deserve. It will assist with identifying patient needs and providing alerts if the needs are not being met.

• The data does not leave our proton therapy facility 
• The patient cannot be tracked outside of our proton therapy facility 
• The data is not used for any commercial purpose, or any purpose unrelated to providing better patient care

The RFID antenna is located in the patient badge. It does not emit any signal on its own. It is only active in our proton therapy facility. It does not communicate any patient-related data, and there is no need to worry about carrying it outside our proton therapy facility. The antenna just communicates its serial number, which is not associated with the patient name or any other personal information in a way that would compromise the patient’s privacy.

We’re dedicated to you while you’re here and after you leave. Follow-up care is extremely important. Your care team will remain in contact with you and your referring physician after you've completed treatment. We focus on giving you what you need to return to a normal life as quickly as possible.

Patient graduation

We celebrate each patient’s final treatment with a graduation ceremony, where they receive a diploma and a challenge coin with a number that is unique to them.

Many U.S. insurance providers, including Medicare and many state Medicaid programs, cover proton therapy treatments. We provide each patient with a patient care coordinator who is able to help with understanding insurance coverage, estimated costs associated with treatment, and assist in finding alternative financial solutions for individuals without insurance coverage.

Financial assistance is available to those who reside within Washington state, and who fall below certain income thresholds. Your patient care coordinator can help you determine if you might qualify and assist with the completion of applications.

Other considerations to be aware of:

• Pre-Authorization may be required by your insurance plan.
• Private insurance coverage depends on the health insurance carrier and the benefits covered under a patient’s plan.
• Before starting treatment, your patient care coordinator will provide you with an estimated out of pocket cost for your treatment.

Our patient care coordinator will assist you in understanding your insurance coverage, coordinating insurance payments, and finding alternative means of financing. To contact one of our patient care coordinators, please call 206-306-2800.