Proton Therapy Access That Puts Patients First with Jennifer Maggiore
Episode Summary
In this episode of The Cancer Project podcast, David Raubach sits down with Jennifer Maggiore, Executive Director of the National Association for Proton Therapy (NAPT), to trace her unlikely path from oncology social work to leading the nation’s most prominent proton therapy advocacy organization. Jennifer began her career embedded in radiation oncology departments, where she developed a firsthand understanding of the daily burdens cancer patients face — financial, emotional, and physical — during weeks-long treatment regimens. That clinical intimacy, she explains, became the philosophical foundation for everything NAPT does today: keeping the patient at the center of every policy push, every insurance appeal, and every new center opening.
Jennifer recounts her pivotal role at Acriman Cancer Center in Jacksonville, Florida, one of the first physician-owned, freestanding proton therapy centers in the United States and only the second Mevian (then Still River) single-room center to come online. Working closely with Dr. Scott Arian for over 15 years, she helped build the social work infrastructure — individual counseling, patient navigation, insurance advocacy — that became a model for community-based proton centers. The challenges were substantial: limited reimbursement, a skeptical insurance environment, and no established blueprint for a private-practice proton center. Yet the experience proved that a multimodality, community-focused model could work, a lesson the broader industry is still absorbing.
A significant portion of the conversation focuses on the access gap in proton therapy. Jennifer presents a stark statistical picture: roughly 2 million Americans received cancer diagnoses in 2024, approximately 1 million of those require radiation, and a conservative 20 percent estimate places 200,000 patients as candidates for proton therapy. Yet only about 18,000 patients received proton treatment last year — fewer than 2 percent of all radiation episodes — and only 9 percent of eligible patients currently have geographic access to a proton center. With one proton room available per 3 million Americans, Jennifer argues forcefully that the industry’s problem is not oversaturation but profound undersupply, a fact she uses to push back on critics who cite high-profile center closures as evidence against further development.
Jennifer outlines NAPT’s multi-front advocacy strategy in Washington, D.C., where the organization engages CMS, HHS, the White House, congressional offices, and Medicare Advantage plan administrators to counter the narrative of proton therapy as a high-cost, low-value modality. She highlights the organization’s health economics research initiatives — including a grant to Dr. Frank whose work demonstrates reduced hospitalizations, fewer ER visits, and lower total cost of care when toxicity to healthy tissue is minimized — as the evidentiary backbone for that advocacy. She also notes a landmark study soon to be published in The Lancet showing improved overall survival in head and neck cancer patients treated with proton therapy, a development she sees as a turning point in how payers and policymakers perceive the modality.
The episode closes with an optimistic look at the near-term future: the University of Wisconsin and Southwest Florida Proton — a community center modeled on the Acriman approach — are set to open, NAPT’s annual conference in San Francisco drew nearly 400 attendees (up from roughly 50 a decade ago), and approximately 70 percent of NCI-designated cancer centers either have proton therapy or are actively developing it. Jennifer and David agree that the industry has moved decisively from defending the technology’s existence to scaling its reach, supported by stronger reimbursement arguments, smarter single-room center economics, and a proton therapy community that, as both guests note, has shifted from competitive to genuinely collaborative.
What You’ll Learn in This Episode
- Oncology Social Work as a Foundation: Jennifer’s career began as a licensed oncology social worker inside radiation oncology departments, giving her direct insight into the emotional, financial, and logistical barriers patients face during 4-to-8-week daily treatment courses — insight that still drives NAPT’s patient-first philosophy.
- Proton Therapy Access Gap: Of an estimated 200,000 U.S. patients annually who qualify for proton therapy under conservative Group 1 Astro indications, only about 18,000 received it in 2024 — less than 2 percent of all radiation episodes — because only 9 percent of eligible patients live near a proton center.
- One Room per 3 Million People: Current U.S. proton capacity sits at roughly one treatment room per 3 million Americans, meaning the industry faces a capacity shortage rather than the oversaturation often cited by critics; Jennifer uses this metric to argue that even multi-center markets like Jacksonville are not over-served.
- Single-Room Centers as the Growth Engine: The emergence of single-room proton systems — originally Still River, now Mevian — dramatically lowered the capital barrier to entry and made community-based, physician-owned centers like Acriman in Jacksonville viable, a model Jennifer sees as the primary vehicle for expanding geographic access.
- Insurance Denials and Denial by Delay: Jennifer distinguishes between outright denials and “denial by delay,” where prior authorization processes cause patients to wait weeks before starting treatment; she notes that most Medicare Advantage cases that go through appeal — roughly 80-85 percent of commercial and MA cases — are ultimately approved in the patient’s favor.
- Health Economics Research Initiatives: NAPT has funded research — including work by Dr. Frank drawing on CMS data — demonstrating that fewer hospitalizations, reduced ER visits, and avoided adverse side effects make proton therapy cost-effective for the health system overall, even though the per-fraction cost exceeds conventional radiation.
- Total Cost of Care vs. Upfront Cost: An MD Anderson / University of Texas study Jennifer cites found that even though proton therapy cost more upfront for head and neck cancer patients, total cost of care was actually higher for conventionally irradiated patients because of downstream management of severe side effects — a framing NAPT now uses in D.C. briefings.
- Overall Survival in Head and Neck Cancer: A study led by Dr. Frank, soon to be published in The Lancet, shows a statistically meaningful improvement in overall survival for head and neck cancer patients treated with proton therapy versus conventional radiation — a landmark data point for the reimbursement and policy debate.
- Theranostics Cost Comparison: A single injection of Lutetium-177 PSMA (used in metastatic prostate cancer) costs approximately $50,000; a full six-injection course runs $300,000 — two to five times the cost of a full course of proton therapy — illustrating that proton therapy is comparatively economical within the broader oncology treatment landscape.
- NAPT’s Four Strategic Pillars: The organization’s roadmap is organized around research (including health economics data and a biannual research forum), advocacy (engagement at CMS, HHS, congressional, and White House levels), education (annual conference, webinars, peer-to-peer learning), and mission sustainability (supporting existing members and new center development).
- Bipartisan Political Support: Cancer crosses party lines, and Jennifer reports that congressional representatives from both sides of the aisle actively champion local proton centers; she encourages member centers to invite elected officials to patient events and facility tours as a grassroots complement to NAPT’s federal advocacy.
- Community Collaboration Over Competition: The proton therapy community has shifted from a competitive posture — common in the early years when fewer than 50 people attended NAPT conferences — to a collaborative one in which centers openly share best practices, appeal strategies, and operational learnings, a dynamic both David and Jennifer credit for the industry’s resilience.
Jennifer Maggiore’s journey from oncology social worker to national advocate encapsulates everything The Cancer Project stands for: meeting patients where they are, understanding the systemic barriers between them and the best available care, and doing the unglamorous policy and community work required to dismantle those barriers. Whether she is sitting with a head and neck cancer patient who cannot swallow, navigating a Medicare Advantage appeal, or briefing a congressional office on proton therapy’s total cost of care advantage, she brings the same conviction — that a treatment this effective at preserving healthy tissue deserves to be available to far more than the 9 percent of patients who can currently access it. If you found value in this conversation, please share it with someone who is weighing radiation treatment options or working in cancer care, and subscribe wherever you listen to podcasts so you never miss an episode of The Cancer Project.
Full Transcript
Read Full Transcript
David Raubach: Jennifer, thank you for joining us today on the Cancer Project podcast. I’m really excited to have you here and just learn a little bit about you and your story and then talk about the proton therapy industry and some of the exciting things that we see happening. First of all, I’d love to get to know a little bit about how you ended up in proton therapy.
Jennifer Maggiore: Well, first, thanks for having me. It’s very exciting. Congratulations on doing this podcast and I appreciate your initiative to make sure we get the word out on the value of proton therapy. My story is I actually started as an oncology social worker many years ago working in a cancer center — specifically with radiation oncology patients — and then moved into leadership roles and had the opportunity to work at the first physician-owned freestanding center in Jacksonville, Florida, with the team at Acriman Cancer Center. I was very honored to be part of that team.
Jennifer Maggiore: We didn’t have a lot of support early on. There weren’t as many proton centers and there was only one other single-room center. So most of these were large room centers like Oklahoma Proton and such. It was multimodality, a lot of different things to think through as you implement that into the center. I joined the board of NAPT hoping to strengthen the support that NAPT would provide to some of these smaller centers, and then moved into this role about six years ago.
David Raubach: So oncology social work — talk a little bit about what that means on a day-to-day basis.
Jennifer Maggiore: Oncology social work is very close to my heart because it’s really focused on supporting the patient through their experience from diagnosis through survival. I had the opportunity to work with patients and really understand what their experience was, some of the barriers they face. With radiation therapy, patients come every day for anywhere from four to seven to eight weeks of treatment, so you get to know these patients at a deeper level. There are a lot of barriers that these patients face, and so I became very committed in my leadership role at NAPT to always keep the patient at the heart of what we do.
Jennifer Maggiore: It’s not just always easy for people to travel to get proton therapy or any advanced treatment. Recognizing what that means emotionally, physically, and financially to leave your home — and why it’s so important to advocate to make sure that patients have access to this in their own region. The vision of NAPT is to ensure that every patient has informed access to proton therapy, empowered by advocacy, education, and research.
David Raubach: Did you have a personal experience with cancer or a family experience with cancer? What led you to the field of oncology, or was it just that there was a job and you were a social worker?
Jennifer Maggiore: No, I was actually a business major. I was very much going to be an entrepreneur, which probably helps me a little bit in the leadership role I’m in now. I started taking required sociology classes and I was really touched by the mission around social work — empowering people, not enabling them, through whatever they’re going through. Healthcare was always an interest of mine. My dad was not very happy that I transferred into social work, but I was able to make this career into something where I can advocate for patients on that level and do that in a macro way in DC.
David Raubach: Yeah, I think that really started with some of the early centers like Loma Linda, MGH, MD Anderson, and UFPI, where they really established what it meant to exist as a proton center and what it meant to treat patients. In Oklahoma we’ve tried to maintain that. Our first patient services lead — her husband got treated at UFPI and she went there and learned about their patient services program, and then we took that and established it in Oklahoma when we opened in 2009. Part of what we tell our staff is we want every patient who leaves this facility to say this was the best healthcare experience they’d ever had.
Jennifer Maggiore: Yes. We had a very strong program of licensed clinical social workers at Acriman that provided everything from individual counseling to patient navigation to connecting patients to resources. I think our proton centers do a phenomenal job with that, whether it’s from the beginning of navigating the patient through the system or even being an advocate through the insurance and appeal process. I was just visiting one of our centers in Ohio and their intake person was phenomenal — a patient actually came out specifically to thank her for supporting her when her insurance denied the case and she had to wait about two weeks to start treatment.
David Raubach: Were you at Acriman before the proton center opened?
Jennifer Maggiore: I was.
David Raubach: So take us back to those conversations. What was it like thinking about doing protons, especially as a small private practice?
Jennifer Maggiore: I’ve known Scott Arian for about 30 years. We met at the hospital and he’s always been a champion for patients, always wanted to bring the best care to them and a champion for the community. We both worked at a Catholic hospital — St. Vincent’s — where our mission was to treat all patients through that door whether they had the ability to pay or not. That commitment continued when he opened his own private practice. Not many private practices had social workers, but he knew it was important to get patients lodging, transportation, and insurance coverage. This was before the days of the Affordable Care Act, so we had a significant number of uninsured patients in Jacksonville.
Jennifer Maggiore: He had a vision to bring proton therapy to Jacksonville. UF was the sixth center in the United States and has been open 20 years. He very much knew that was going to be the future. He’s very much a visionary. A lot of people doubted whether a small private practice could do that. You have to have a champion — someone that really believes in this — because it is not easy to plan and develop and bring a proton therapy center to even a freestanding area. It takes a lot of grit, dedication, and perseverance, and you have to have a staff that believes in it as well.
David Raubach: So UFPI opens in 2006. When were you guys having those conversations?
Jennifer Maggiore: It was really when Mevian — then Still River — announced they had a single-room solution. Dr. Arian knew some of the physicians at Washington University in St. Louis, and there was a commitment to how we could bring more single-room centers. The single-room center really is the perfect opportunity. UF being the legacy center brought that to the academic setting in Jacksonville. The city was very supportive of having proton therapy as well. We also know that treatment needs to be accessible from outpatient centers. Not every patient has the ability to access each health system in their community — there are different insurances, different barriers — so it really does benefit a community to have a variety of providers that can offer this solution.
David Raubach: That’s interesting because we were going through something very similar in Oklahoma. You had ProCure announce construction of their IBA facility, and then the University of Oklahoma pretty quickly said they were going to do protons and selected a Still River single-room system about the same time that Scott did. So we were kind of running parallel to each other, although the roles were a little bit reversed — we were the freestanding facility with the IBA system and OU was the academic facility trying to get a Still River single-room system.
David Raubach: Can you have two proton centers in a market?
Jennifer Maggiore: Absolutely, yes. Two reasons. First, I’ve seen it work. Second, look at the stats: 2 million Americans were diagnosed with cancer in 2024; 1 million of those need radiation per Astro and AdvaMed and other studies. If you take a conservative 20 percent of those needing proton therapy, that’s 200,000 patients. Right now, only about 18,000 patients received proton therapy last year — less than 2 percent of all radiation episodes. Only 9 percent of patients who need proton therapy have access to it. So we actually have one room per 3 million people. We do not have enough capacity. We need more.
Jennifer Maggiore: I push back very strongly on the “too many centers” argument. Patients need their choice. Maybe they have a prior physician, maybe they’ve been getting cancer treatments and want care at that center. We also have more studies showing benefit. Dr. Frank has a study soon to be published in The Lancet showing higher overall survival for head and neck cancers with proton therapy. So we need more capacity for these patients.
David Raubach: In Oklahoma City we have two centers. The University of Oklahoma has a single room; we have four rooms at the Oklahoma Proton Center. There are about 6,000 — probably closer to 7,000 now — patients who will be diagnosed with cancer in the Oklahoma City metro this year, so roughly 3,500 radiation patients. Dr. Herman Suit, a pioneer in proton therapy who worked at the Harvard Cyclotron Lab, had a famous statement that complications don’t occur in cells that aren’t exposed to radiation. The gist is: why would you ever want to deliver excess radiation to healthy tissue?
Jennifer Maggiore: From a payer standpoint, if you have two different modalities, one more expensive than the other, you want proof of benefit — and which patients benefit the most. We know IMRT has advanced, just as proton therapy is evolving with pencil beam scanning, and now we’re looking at FLASH therapy. There are certain cases where conventional radiation is appropriate. What we really need to do is define the subset of patients who benefit the most from proton therapy, because it is still a limited resource. Many of our single-room centers are having to triage who benefits the most. I don’t want that to be the reality — I want every patient who truly needs this treatment to be able to access it.
David Raubach: So you joined the board of NAPT, and you’re now the executive director. What happened with that transition?
Jennifer Maggiore: In 2019, our previous executive director, Scott Warwick, moved into a different position. Being on the board of directors gives you a very keen insight into the strategic priorities and importance of an organization like this. This was an opportunity I felt I could advocate for patients at the macro level and for our members in a very unique way. It was very hard to leave — I had been at Acriman Cancer Center for over 15 years — but this is an opportunity to help Acriman and all of our members in a larger way. We now have a presence in DC that we never had before.
Jennifer Maggiore: Dr. Machi, our FDA commissioner, just said in a recent meeting in front of HHS Secretary, the CMS administrator, and the president that the U.S. leads the world in proton therapy. We’ve changed the narrative in just the last five or six years from proton therapy being viewed as a wasteful, high-cost, low-value technology to it being recognized as the best in the world. That is really due to the work all of our members do with NAPT, but also our researchers and clinicians who are publishing the evidence.
David Raubach: I remember going to NAPT in 2010 and I think there were maybe 50 of us in the room. Now we have almost that many centers that are open in the U.S. There really has been a paradigm shift — from this being a unique treatment with not that many centers, to now every top academic program saying we have to have this modality if we’re going to continue to be a top academic cancer center, but also physician-owned groups and community hospitals putting in proton therapy.
Jennifer Maggiore: About 70 percent of NCI-designated centers either have the technology now or are in development. Duke just recently announced their system, and Southwest Florida Proton — Dr. Shannon McDonald is speaking at Astro this afternoon — is a community center similar to what Acriman did in Jacksonville. This year we’ve only had one opening, and I wouldn’t call this prolific growth — it’s a steady, strategic growth. We’re also starting to see more AYA patients. We’ve never seen this many younger people diagnosed with cancer before. The American Cancer Society is digging into this, and until we know the reasons why, we definitely have to be positioned to make sure these young people have treatment that is kind to their bodies so they can maintain their fertility and have their life ahead of them.
David Raubach: When you talk about advocacy in DC, what specifically are you advocating for?
Jennifer Maggiore: Our main support is the sustainability of our proton centers and hospitals that provide this treatment, and we do that by ensuring adequate reimbursement. The only way to ensure adequate reimbursement is to show value. We have funded two health economics research initiatives. Dr. Frank is a recipient of one of our grants, and we have pulled CMS data showing less hospitalizations and fewer ER visits — all of that saves the system money. We’re constantly telling the story of the value for the patient and also for the healthcare system, because when you have a higher-cost treatment upfront, you want to show all the aspects of how it is valuable.
David Raubach: I remember the paper that MD Anderson did with the University of Texas. They looked at head and neck cancer patients and even though proton therapy was more expensive upfront, the total cost of care was actually higher for patients who got traditional radiation because of all the side effects.
Jennifer Maggiore: Exactly. Adverse side effects cost the health system money and they cost patients money too. We’re also telling the story of prior authorization being a national issue — it’s very acute in our world. When you have a treatment that’s been labeled low-value and high-cost in the past and you’re switching that narrative, it is much harder to educate insurers on this value. Louisiana just passed their own legislation on patients’ rights around prior authorization. And as more Medicare beneficiaries are now under Medicare Advantage plans, this is a key issue. We have Medicare Advantage beneficiaries being denied treatment that their next-door neighbor can get under traditional Medicare — a real inequity of access.
David Raubach: We had a patient at the Oklahoma Proton Center who didn’t get approved for protons and was going to need treatment on a linear accelerator. They were in the lobby and saw a brochure showing a comparative treatment plan — the radiation exposure to healthy tissue with traditional radiation versus protons for their specific disease site. The moment that patient saw that image, they were very upset. That was a person who was denied care that almost certainly would have been better for them. They had the trauma of cancer, plus the trauma of their insurance company saying you’re not going to get the care your doctor is recommending.
Jennifer Maggiore: It definitely impacts people. I get calls from patients about twice a month on this issue. I work with them and tell them that their proton centers are very well equipped to help support them. We also have an insurance and appeal toolkit to help patients understand what a second appeal is, what a peer-to-peer review is, how to understand their benefits, whether they have a self-funded plan and can work with their employer. What’s interesting is that most of these cases — especially Medicare Advantage plans — are overturned in the patient’s favor. It’s really denial by delay. We don’t want people to avoid seeking proton therapy because they’re worried about the prior authorization process. Go through the process — it can work and it does work.
Jennifer Maggiore: When we tell this story in DC, the Congress members are very proud of the proton centers in their communities. They actually talk about it and want to safeguard it. Cancer is bipartisan. When I go to DC, I work with all sides on this issue, which is very refreshing. We engage with all levels of policymakers — CMS, HHS, the White House, the vice president’s office. We’ve done all kinds of visits in the past five years.
David Raubach: We get about 80 percent of our commercial pay and Medicare Advantage cases approved — maybe even 85 percent — and that’s honestly up from 15 years ago when we may have been at 50 or 60 percent. Things are getting better. That first no doesn’t have to be the final no. What are some of the things you’re excited about for the next five years?
Jennifer Maggiore: Short term, I’m excited to welcome new members. University of Wisconsin will open next year. Southwest Florida will open later this year. It’s exciting to see new energy come into the organization. We also had a reception here in San Francisco on Saturday night — we expected about 50 people and had 100. Our conferences are now close to 400 attendees rather than 50. We have a very clear strategic focus organized around four pillars: research, advocacy, education, and mission sustainability. We are also the only organization that monitors the trends and outcomes in proton therapy. We put out a press release today with some of our member survey results that really help you understand the state of proton therapy.
David Raubach: You mentioned that theranostics is an emerging field. A single injection of a radioactive agent used in the treatment of metastatic prostate cancer costs $50,000, and a patient typically gets six injections — $300,000 for that particular drug. That’s anywhere from double to four or five times what a course of proton therapy costs a payer. So yes, proton therapy might be more expensive than traditional radiation, but in the grand scheme of the cost of caring for cancer, it’s actually relatively small.
Jennifer Maggiore: Radiation oncology as a whole is a very cost-effective treatment when you compare it to pharmaceuticals. When you talk to people outside our realm and ask them, “Why wouldn’t we pay more for this type of treatment that spares healthy tissue?” — it’s a pretty clear answer. We have had to really defend the cost of this treatment for years, and some of those arguments against it are not valid. That’s exactly why the research is so important: so we can back up our argument that this is truly a beneficial treatment for many patients with cancer.
David Raubach: You mentioned the overall survival element. Think about it — you’re literally talking about a specific disease site where protons versus photons could actually lead to a patient living longer. What’s the value of that? What price do you put on extending life for patients?
Jennifer Maggiore: Extending life, getting back to work, avoiding tube feedings, avoiding dependence on certain medications — I worked directly with many head and neck patients in my social work days and I saw the differences when some of these patients were treated with proton therapy. Those patients got back to work quicker. When you see that firsthand, these are patients in their 50s and 60s with children they’re supporting, children in college. They want to get back to work and have a life. When you lose the ability to swallow, when you can’t go out in public because you don’t feel well, you’ve lost so much weight — that is the real advantage of reducing the side effects of treatment.
David Raubach: I want to close the loop on the narrative about proton center failures. There have been maybe a couple of high-profile, large facilities — four or five rooms — where from a cost standpoint the capital investment made at the time was not sustainable. But most of those have been restructured. The center in Oklahoma was doing about 350 patients a year around 2016-2017-2018, shut down, we bought it and reopened it, recruited new doctors who were dedicated and focused, and we’ll treat 750 patients this year. If you have a good business model and you do things the right way and operate efficiently, you can make a center successful.
Jennifer Maggiore: It’s a high-cost investment to develop the center, and significant resources to maintain it. Most people don’t realize that proton centers have on-site engineers living in that city working there — this is not an inexpensive proposition to maintain. But having that champion going back to that message is extremely important. You took that center, saw its importance for the community, and figured out how to make it financially viable. Then there were insurance companies pulling back reimbursement, and COVID was a real issue for many centers on a thin margin. That’s not unique in healthcare — we’re seeing this now with rural hospitals as well. We need federal policy support for adequate reimbursement to support these community centers, because they are very important for every region in the United States.
David Raubach: I think a couple out of 50 centers not doing as well is to be expected in any industry, and they tend to be high-profile because proton centers are high-profile projects. There’s been lots of cancer centers and hospitals that have shut down or gone through restructuring. Think about AI companies — there will be many that start up and fail, but you don’t say we’re just not going to do AI. The takeaway is that just like in every other industry, a few projects don’t work the way they’re supposed to, and that’s not a reason not to invest in proton therapy. Costs are coming down, we understand how to make centers successful from an operational standpoint, and we have a better understanding of what patients to treat and when. MD Anderson just opened a second center. Mayo is building a third facility in Jacksonville with carbon ion and expanding in Rochester. Look at what the top cancer centers are doing — they’re at the forefront.
Jennifer Maggiore: Thank you so much for having me. It’s just a delight to be able to talk to you in this casual forum. I’ll see you soon in Nashville.
David Raubach: Yep. Sounds good. Thank you so much, Jennifer. I really appreciate your time and everything you do for the proton therapy community and for patients.
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