Web-based system to promote long-term patient reporting at Roberts Proton Therapy Center

When a proton therapy center draws cancer patients from hundreds of miles away, it’s easy to lose track of them two or three years after treatment. And that severed connection means oncologists lose access to critical data about the long-term health and quality of life experienced by these proton therapy patients.

Are patients still cancer-free? Is their quality of life as good as or better than conventionally treated cancer survivors? Have they experienced any secondary cancers or any treatment side effects? These all-important measures, that affect physician referrals, standards of care and reimbursement, don’t have to go unanswered simply because of time and distance.


For James Metz, M.D., the Internet bridges time and distance for so many things, so, why not use it for long-term follow up with proton therapy patients and their families? The largest proton therapy center in the world begins treating patients in fall 2009. From the first day, Metz and his peers want to ensure consistent patient self-reporting from initial treatment through remission and into the cancer-free years. To do so, they’ll be using a web-based patient reporting tool developed by VisionTree Software of San Diego, California. VisionTree’s palette of software products includes VisionTree Optimal Care, a secure web-accessed health information management system that collects and stores patient health records, consent forms, reminders, doctor-patient messages, instructions and outcomes data.


The program has been utilized by patients and practitioners at UCLA Medical Center in Los Angeles, California; Henry Ford Hospital in Detroit, Michigan; and many other health care facilities. “Many proton therapy centers lose their ability to follow up regularly with patients over the long-term, particularly those patients who have traveled very long distances for treatment,” says Metz, a radiation oncologist at the Abramson Cancer Center  at the University of Pennsylvania in Philadelphia, Pennsylvania. Metz is a member of the team organizing the treatment systems at the nearby Roberts Proton Therapy Center. “By using VisionTree, we can follow patient symptoms, side effects and quality of life much longer and with greater regularity than we could before.”


At least 3,000 cancer patients a year are expected to be treated at the Roberts Proton Therapy Center. VisionTree’s Internet-based software has won raves from many of the nearly 100,000 patients who have used the tool to access their health records, answer regular health assessments and communicate directly with their physicians. “There’s big potential down the road for linking the clinical data being collected by several proton therapy centers assessing common protocols,” Metz adds. “A tool like VisionTree will allow for a much higher degree of multi-center collaboration,” he says. “It’s going to allow for proton therapy clinical trials to be done better, collecting patient data that can demonstrate efficacy, improved quality of life — and value to our health care system.”

Roberts Proton Therapy Center

PT clinical trials could enroll nearly 1,500 patients in the U.S.

Cancer clinical trials using proton therapy are ongoing, with about 25 under way in the United States.

According to current information from the National Institutes of Health (NIH), several studies are in the data collection phase, while others are recruiting patients. A total of about 1,470 participants have been recruited or are being sought for cancer studies involving proton therapy. A number of cancers may be effectively treated with protons exclusively or in combination with other therapies.

The chart at right offers a quick snapshot of current U.S. cancer clinical trials being conducted using either of these methods. These trials, along with more effective reporting mechanisms (e.g. web-based system allowing long-term patient reporting) are important to continue to assess the effectiveness of proton therapy for numerous cancers, as well as quality of life and the incidence and severity of treatment related side effects.

Quality assurance helps advance standardized procedures

Greater refinement of quality assurance (QA) procedures across proton therapy centers today will help ensure they remain valuable to future centers, putting them steps ahead of the game.

There are two types of quality assurance: system and patient-specific. “System quality assurance refers to the daily, weekly, monthly and yearly QA assessments we use to test each gantry and the overall machinery associated with proton therapy delivery,” says Roelf Slopsema, M.S., physicist at the University of Florida Proton Therapy Institute (UFPTI). “For example, the daily system quality assurance procedures we perform measure output — specifically, to ensure we have the same amount of dose at isocenter — and the alignment accuracy of patient to proton beam. “Patient-specific quality assurance concerns the measurement of treatment fields in a water phantom to ensure accurate dosage and treatment penetration depth, in addition to hardware quality,” Slopsema continues. Hardware QA procedures test the range compensator and aperture, two proton therapy components that ensure proper dose distribution.

Quality assurance procedures can be time-intensive, and UFPTI’s three gantry treatment rooms each undergo approximately 20 minutes of QA procedures daily, an additional 60 to 90 minutes weekly, and another 30 minutes on a monthly basis, in addition to extensive annual QA testing. As various fields are measured and the system remains stable, physicists rely on previous measurements as references for future QA assessments. Slopsema garnered much of his QA expertise during his tenure at Massachusetts General Hospital in Boston, Massachusetts. He’s applied this knowledge to his work at UFPTI and says this type of information sharing between proton therapy centers will help refine and improve future QA procedures. “With so few proton therapy facilities in operation today, there’s no real set of QA standards yet, so each center is developing its own set of standards,” says Slopsema. “As more proton therapy systems come online, the more streamlined quality assurance procedures will become.”

Though many alignment, setup and imaging learnings carry over from conventional radiation therapy, the transition to proton therapy requires equipment-specific training due to the increased complexity of proton therapy mechanisms. Teaming proton therapy with other radiotherapy modalities makes centers more flexible and allows to treat more patients, as a number receive a combined cancer therapy regimen of photons and protons.

The first goal of quality assurance is to deliver safe and accurate treatment to patients. “It is important for proton therapy professionals to understand the system they are working with,” says Slopsema. “Physicists need to be familiar with the process of proton generation, the proper dosing and all of the varying elements. Taken in total, these components define the quality assurance procedures necessary to run a safe and efficient operation. And patients expect safety when they walk through the door.”