Clues to address barriers for access to proton therapy in the Netherlands

The Netherlands has National Indication Protocols on proton therapy (PT) to select patients who benefit most from PT. However, referrals to proton therapy centres (PTCs) are lagging. The objective of this research is to identify the barriers for access to PT and to design interventions to address these barriers.

We conducted a nationwide survey among radiation oncologists (ROs), and semi- structured in-depth interviews with ROs and patients. Subsequently, four workshops were held, in which ROs from one PTC and ROs from referring hospitals participated. The workshops were based on design-thinking research, where ideas were co-created on a multidisciplinary basis to encourage joint problem ownership. Kruskal Wallis and X2 tests were used to analyze data.

The most prominent barriers mentioned by ROs were patient selection, poor logistics, and logistical worries about the combination of radiation treatment with chemotherapy. Patients pointed out the inefficient coordination between organisations, poor communication, travel issues and discomfort during treatment. Clues to increase referrals revealed the need for additional tools for patient selection and innovative ways to improve logistics. A case manager was identified as beneficial to the patients' journey as part of a multidisciplinary approach. Such an approach should include the active involvement of medical oncologists, surgeons and pulmonologists.

Barriers for access to PT were identified and prioritized in the inter-organisational care- pathway of proton therapy patients in The Netherlands. Innovative solutions were co- designed to solve the barriers.