• 9/19/2006
  • Boston, MA
  • Liz Kowalczyk
  • Boston Globe (Boston.com)

The rising number of Massachusetts residents with cancer will outstrip the capacity of radiation treatment facilities within four years, say public health officials, who for the first time in 13 years are asking hospitals that do not already offer such therapy to build expensive new treatment centers.

Doctors will diagnose 38,248 residents with cancer in 2010, health officials estimate, 18 percent more than the number of new cases diagnosed in 2000. Treating these patients will require at least eight additional multi-million-dollar radiation facilities, and health officials in July changed state regulations to allow more hospitals to build such centers.

The facilities cost at least $5 million to build, largely because the machine that produces the radiation must be housed in a thick-walled vault to keep the damaging rays from escaping. It’s unclear how many smaller hospitals will be willing to shoulder the expense. “That’s the million-dollar question,” said Anuj Goel, attorney for the Massachusetts Hospital Association , which is a nonprofit group . “It’s all based on money and resources and patient need.”

If hospitals don’t build enough radiation oncology facilities, patients could experience longer waits for therapy. Radiation therapy is one of the most common treatments for cancer, with about half of the patients requiring it to shrink their tumors, state officials estimate. And doctors expect radiation therapy to be used for more types of cancer in the future, meaning the state could be underestimating demand for the service.

While once considered a blunt instrument, radiation, like drugs, is becoming more targeted. It is increasingly used as a substitute for surgery, particularly in treating head and neck cancers and early-stage lung cancer, radiation oncologists said. New computer programs that produce three-dimensional images of a patient’s tumor allow doctors to better train the rays on the cancer and spare healthy tissue.

“It was a field that played largely a supportive role for many years to surgery; it was not in the lead. But that has changed,” said Dr. Paul Busse, clinical director of radiation oncology at Massachusetts General Hospital.

Preparations for a rise in cancer patients are not confined to radiation treatment. Dana-Farber Cancer Institute in Boston has applied for city approval to build a 13-story clinical center that will include roughly 100 additional exam rooms and 140 additional chemotherapy infusion chairs. Executives predict patient visits for exams, blood tests, and certain treatments will more than double in 10 years, reaching 235,000 by 2015, while visits for chemotherapy will more than triple to 189,000.

State health officials say the graying of the population is driving the need for facilities. Individuals born during the post-World War II baby boom are starting to reach 60, an age when cancer becomes far more prevalent. People in their early 60s are six times more likely to get cancer than people 20 years younger. Not only are there more cancer patients, but patients are having more treatment, doctors said.

Patients with advanced lung cancer, for example, until recently had no other options if chemotherapy treatment failed. But with the development over the past five years of targeted non-chemotherapy drugs, including Tarceva and Avastin, patients can undergo two or three additional rounds of treatment.

Many breast cancer patients who used to have chemotherapy infusions once every three weeks now routinely come in for their medication every week or two, as doctors have discovered that lower but more frequent doses of certain drugs are more effective.

Treatment increasingly prolongs patients’ lives, doctors said, and they sometimes will develop cancer again years later, requiring more therapy.

“Most of our growth is driven by intensity of treatment and survivorship,” said Janet Porter, Dana-Farber’s chief operating officer. “We’re able to do so much more for our patients.”

The state tightly controls the number of radiation facilities hospitals and companies can open, both to control costs and to make sure each facility has enough patients to maintain technicians’ skills. The Massachusetts Department of Public Health calculates the number of expected cancer cases about every 10 years. This year’s analysis showed that the state needs at least 68 radiation oncology units by 2010, but has just 60.

Regulators had allowed only hospitals and companies with existing units to open additional ones — if they could prove they need more capacity. The new regulations allow any hospital or company to open a facility as long as they project a caseload of at least 250 patients annually, and allow community hospitals to get into the radiation oncology business. Applicants must demonstrate that patients currently must travel at least 30 minutes to the nearest facility, or have to wait at least seven days to begin their treatment. Applications are due Oct. 1.

Southcoast Hospitals Group Inc., which includes St. Luke’s in New Bedford , Tobey in Wareham , and Charlton Memorial in Fall River, and where the number of new cancer cases has grown 17 percent in five years, is a possible candidate. And Cape Cod HealthCare is planning to build a new unit but hasn’t settled on a location. Teaching hospitals with existing facilities, including Dana-Farber, also are planning to add units.

Drug treatment also is on the rise, doctors said. Researchers at the National Cancer Institute and Harvard Medical School are analyzing chemotherapy use among Medicare patients with lung, breast, prostate, or colorectal cancer between 1991 and 2002. Preliminary results suggest that in the period immediately following diagnosis, the rate of chemotherapy use rose to 19 percent from 12 percent. The rate of chemotherapy in the terminal phase of patients’ illnesses climbed to 34 percent from 13 percent, said Dr. Elizabeth Lamont, of the Massachusetts General Hospital Cancer Center.

Dr. Bruce Chabner, clinical director of the cancer center, said that, except for smokers quitting, there are few good ways for much of the population to prevent cancer. “As the population ages, we’ll just need more treatment capacity unless there is a breakthrough on prevention,” he said.