After setting the standard for comprehensive cancer care in Vero Beach for the past decade, Scully-Welsh Cancer Center at Cleveland Clinic Indian River Hospital is forging ahead into the future with the goal of leaving no one behind – regardless of ability to pay.
Planning for a second decade and beyond, Scully-Welsh is doubling the number of its specialized oncology physicians and surgeons, drastically cutting wait times for an appointment, and better utilizing top cancer experts across the Cleveland Clinic network.
By adding capacity and eventually a $30-million third-floor expansion to the Scully-Welsh building, hospital Vice President and Chief Medical Officer Dr. Richard Rothman looks to meet the needs of Indian River County’s growing, aging population.
In 2024 the United States hit a grim milestone – 2 million new cancer cases.
In Vero Beach, one in three patients seeking cancer treatment has lymphoma, leukemia or another type of blood cancer. One in five local patients needs treatment for breast cancer or a gynecological malignancy. Next common is gastrointestinal cancer, colon cancer and abdominal cancers, accounting for 17 percent of local cases.
One in 10 local cancer patients presents with lung cancer, and another one in 10 with genitourinary cancers (kidney, bladder and prostate). Head and neck cancers make up roughly 5 percent of those treated at Scully-Welsh.
Better cancer screening, early detection and targeted therapies offer patients greater survival odds and better post-treatment lives. The catch? The explosion of advances in modern cancer care carries a high price tag.
“Most medications are cost-prohibitive for many patients, and the cost of many of those drugs is far beyond what we get reimbursed,” Rothman said.
Chemotherapy drugs can cost $15,000 per dose for the medication alone, plus the cost of oncologists, pharmacists, infusion suites and nursing staff. Cutting-edge biologic and immunotherapy treatments can run into six figures.
In 2024, Cleveland Clinic treated 4,725 chemotherapy patients at Scully-Welsh, up 20 percent from 3,949 patients in 2023. Of those, 589 either had no means to pay or were on Medicaid.
The most common cancers treated in this charity-care group were various types of cancers of the blood (179 patients), breast cancer (186 patients), head and neck cancers (48 patients) and malignancies of the gastrointestinal tract such as colon cancer (94 patients). The total cost of just the chemotherapy drugs for these indigent patients was $1.4 million.
“We’re not just offering it to patients who have a payer or who can self-pay, and there’s no other place in the county where they can go for that care,” Rothman said, noting that he’ll be hiring five new hematologists and medical oncologists soon to expand chemo access.
Cleveland Clinic is still negotiating with the Indian River County Hospital District to obtain $13.6 million in taxpayer money over four years for charity care, some of which would underwrite chemotherapy and other cancer treatments.
“Not everyone is getting the care they need. How do we both internally and externally partner to ensure that all members of the community are able to have access to this care? It’s a complex conversation made more complicated by the finances of delivering healthcare today,” he said.
Radiation oncology – the use of targeted high-energy waves to shrink tumors and relieve pain – is in high demand in Vero Beach with 40 to 50 treatments performed per day. On average in the U.S., one typical 10-minute treatment costs $5,000 to $10,000.
In 2024, Cleveland Clinic delivered 11,825 radiation oncology treatments, up 3 percent from 2023. Of the patients treated with radiation in 2024, there were 279 who were unable to pay – an increase of 400 percent in the past five years.
“The Scully-Welsh Cancer Center Radiation Oncology Department is one of the most advanced radiotherapy centers in Florida,” Rothman said, noting that much of the high-tech equipment now used in Vero is even newer than machines at Cleveland Clinic Florida’s flagship Weston hospital.
Radiation oncologist Dr. Marc Apple, a Cleveland Clinic Florida doctor who moved his practice to Vero, used the TrueBeam to treat a patient with prostate cancer during Vero Beach 32963’s tour of the center.
“We have the only technology in Indian River County, such as multiple TrueBeam radiation therapy machines that offers precise and fast radiotherapy. This allows for sub-millimeter accuracy to enhance elimination of cancer while minimizing side effects and enhancing the safety of the radiation therapy,” Rothman said.
“A radical prostatectomy may have side effects that are well beyond what the patient may be willing to tolerate, where radiation therapy for that same prostate cancer may allow for him to preserve his quality of life and not have to undergo surgery.”
Rothman said patients come from across the Treasure Coast, and he expects that number to grow as he’s hired a third radiation oncologist to help handle the caseload.
Nearly 900 patients had cancer surgery of the head and neck, lung, prostate, GI tract, skin, spine, brain and breast – with simultaneous breast reconstruction. A second reconstructive plastic surgery specialist, and a third head-and neck specialist have just been hired.
No matter the type of cancer, the stage to which it’s progressed, patients typically want answers and a treatment plan immediately after getting an initial cancer diagnosis.
Rothman has charged Scully-Welsh’s Co-Directors Dr. Brian Burkey and Lori McCormick with getting every new cancer patient seen as soon or sooner than they would be able to get an appointment at an out-of-town cancer center – but that will take more work to achieve.
“If a patient calls and we say we can see them in a week, and they call Moffitt and Moffitt says they can get them in tomorrow, they’re going to drive three hours to Tampa. That’s an excruciating week,” Rothman said. “In addition to best-in-class outcomes and experiences for patients with cancer and those caregivers treating them, the Scully-Welsh Cancer Center leadership’s primary focus is ensuring patients needing urgent evaluations for a diagnosis of cancer can be seen immediately and do not have to wait to see a clinician.”
When at its full complement of physicians, Cleveland Clinic Indian River will employ 30 local doctors and surgeons specializing in cancer, including two palliative care experts.
Even with those reinforcements, rare and complex cancers may require a second opinion, so Rothman purchased a $600,000 digital pathology machine in January so high-resolution tumor images can be sent to specialists who exclusively treat certain cancers at Cleveland Clinic’s locations worldwide.
“Our sites across the globe work together. So as the enterprise department chair, my role is to make sure the quality of care provided in Ohio, in Florida, and in Abu Dhabi is going to be the same,” said Dr. Jame Abraham, who heads up Cleveland Clinic’s main campus Hematology and Medical Oncology Department, speaking at the Feb. 18 Becker’s Oncology Summit.
He’s treated and researched only breast cancer for decades, so Vero doctors can bring Abraham in to consult.
“So let’s just say, there is a complicated case we have in Abu Dhabi. They’re discussing it at our tumor board in Ohio. It’s similar to a complicated case in London that will be discussed in a meeting in Ohio,” he said. “We learn from each other, share our expertise across our geographical sites. And so that’s the clinical care. And then of course, the science is the same way.”
“It’s really a team of teams working together to take care of our patients,” Abraham said.
McCormick coordinates all those teams at the Scully-Welsh Cancer Center. Brought on in 2014 to head up ambulatory care while the cancer center was still under construction, McCormick ensures the front-desk greeter, surgeons, post-op nurses in the main hospital, pharmacists, infusion techs, volunteers and appointment setters work collaboratively.
“We have a lot of patients who have the means to go back home to get their treatment, but they choose to stay here, even through the summer, because it’s such a comprehensive cancer program,” McCormick said. “The staff here is wonderful. They love our nurses. They are all chemotherapy and biotherapy certified, which brings a greater level of expertise to the care they give.”
But it’s not just about surgeries and chemo, radiation and rehabilitation. Scully-Welsh Cancer Center offers yoga classes, acupuncture, nutritional counseling, smoking cessation classes and even talk-therapy and support groups for patients and family members living with the realities of cancer.
“We offer massage therapy, reiki therapy,” McCormick said. “We have a wig program to help patients who have lost their hair. A lot of it is body image disturbance. Nobody wants to experience that, but this program really helps the patient feel whole again.”
Local donors who designate gifts for cancer patients enable Cleveland Clinic Foundation to provide these integrative health services gratis.
“Individuals who have suffered through something like a cancer benefit from being around others who also have been through that. There’s been a lot of data to support yoga therapy for patients with cancer, but it’s more than just yoga,” Rothman said. “It’s the ability to interact with people who have been through the same thing that you have – who have lost their hair, who have had major surgery, who have sat in that room,” Rothman said.
Once cancer treatment concludes, Scully-Welsh Cancer Center enrolls patients in its Survivorship Program to maintain access to oncologists and assist the patient’s primary care physicians.
Since research shows compliance with follow-up care, physical therapy and screenings improves when care is closer to home, “Scully-Welsh Cancer Center offers the ability for patients who start treatment in a different center to continue their cancer care at Scully-Welsh,” Rothman said.
“The recovery journey for patients is complex and has different steps depending on the type of cancer and the treatment,” he said. “Patients at Scully-Welsh Cancer Center can transition from diagnosis to treatment to living life in remission or cancer-free.”
Photos by Joshua Kodis
