Patients with breast, prostate and some skin cancers will have another treatment option at St. John’s Medical Center by late spring or early summer 2018.
Called brachytherapy, the radiotherapy treatment involves a catheter inserted into the body to place radioactive “seeds” in or near a tumor.
The hospital’s board of trustees approved the administration’s proposal for capital expenditures for the treatment equipment during its Oct. 26 meeting.
Radiation oncologist Ryan Bair said brachytherapy has benefits over traditional radiation treatments.
“I think it’s a great modality,” Bair said. “In prostate cancer, for example, it’s unequivocally better than external beam radiation therapy.”
His resume includes medical school at the University of Utah, an internship at Stanford and a residency at the University of Chicago Medical Center. He earned a fellowship at Harvard Medical School and at nearby Boston Hospital. Harvard was where brachytherapy piqued his interest.
Traditional treatment of prostate cancer takes eight weeks, Bair said. With brachytherapy it takes two or three sessions. Traditional treatment of breast cancer tends to take three to six weeks, whereas brachytherapy take just five sessions.
Limited toxicity is one of the key benefits.
“You can treat things very effectively with a minimal radiation dose to other structures that are nearby,” he said.
That’s why some of his patients drive over Teton Pass to seek treatment at Eastern Idaho Regional Medical Center in Idaho Falls. He said he sees around 30 patients from this area every month.
“It’s a huge inconvenience to come across the pass for extended periods of time,” Bair said. “It’s much easier for me to come over here. For me it’s all about the patients, because Jackson is a rural area.”
Logistics are still being ironed out, but Bair will likely come to Jackson for two and a half weeks and see 15 patients a day.
A big investment ...
In addition to breast and prostate cancers, brachytherapy is popular with skin cancer patients who want as little of a cosmetic impact as possible. It works for squamous cell cancer and basal cell cancer, but not melanoma.
It will be up to Bair to determine when a candidate is appropriate for the treatment.
“I’m a very data-driven person,” he said. “I’ll offer the treatment to people deemed an optimal candidate for it. My job is to make sure I’m aware of the clinical nuances.”
Bringing brachytherapy to Jackson is a substantial investment by the hospital. For starters, the seed implant delivery system must be housed in a vault.
“These are radioactive seeds,” said St. John’s CEO Dr. Paul Beaupre. “So you can’t just have them sitting around and do this in an unprepared room, because people would get radiation from that.”
The vault will cost an estimated $450,000 to $500,000. Beaupre said it will fit in an existing room. That figure, he added, isn’t final; negotiations are underway to get a better price.
For those diagnosed with breast or prostate cancer the process would look similar to this: A mammogram or prostate ultrasound will show a tumor. Then specialists will determine if brachytherapy might be a good fit. If so, a catheter is put in right where the tumor is located. The area is completely numbed, either by local anesthesia or spinal anesthetic, depending on the location. Bair said there is “minimal discomfort during the procedure.”
Since the catheter is already part of operating room equipment used for other surgeries, it’s not an additional cost that would be unexpected to see on a bill.
The device that delivers the radioactive seeds through the catheter costs between $100,000 and $125,000 for the hospital. That brings the upfront cost of starting brachytherapy to between $600,000 and $625,000 for the hospital.
... but it will repay itself
Beaupre said he’s confident the hospital will earn that money back. When Bair initially approached him, an independent company did a feasibility study to determine if the number of patients would repay the investment. Estimates show that 25 patients a year or more would be ideal.
“I’m not worried at all us about us being able to have this piece of equipment pay for itself ultimately,” he said. “And I have no concerns about Dr. Bair keeping his skill set up.”
That’s often how the relatively small rural hospital decides whether to offer services. In addition to costs, St. John’s looks at how many operations surgeons would perform. There needs to be enough demand for a service for doctors to keep their skills up — one reason why brain surgery and heart surgery aren’t offered here.
A quality heart surgery program needs to do at least 200 heart operations a year, even if split between several surgeons. There wouldn’t be that much demand in Jackson Hole.
Hospital staff says the treatment quality will be the same as other places that offer brachytherapy, such as the Huntsman Cancer Institute in Utah or Eastern Idaho Regional Medical Center in Idaho Falls, where Bair currently works. Huntsman will continue to partner with St. John’s to make sure patients are aware of all of their options, including traditional radiation.
“I’m not going to do anything here that I can’t do at the same level as a university,” Beaupre said. “It’s not worth it to us to do it if you can get in a car and get better services.”