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The National Referral Service for Proton Beam Therapy in England: A Journey Towards Equitable Access
1Proton Clinical Outcomes Unit, The Christie NHS Proton Beam Therapy Centre, Manchester, UK; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
Aim:
Health care policies have frequently centred on ensuring equitable access within diverse populations. While new technologies have immense potential for improving health outcomes, they may not be necessarily available across varied geographical areas and socioeconomic backgrounds. The goal of this study is to analyse equity of access to Proton Beam Therapy (PBT) throughout England and how this has changed since the inception of a national PBT service in 2018.
Materials And Methods:
The Proton Utilisation Proportion (PUP) is the ratio between treated and newly diagnosed patients, which measures the proportion of eligible patients using the technology. These figures were provided for 7 of the most prevalent PBT cancer indications for the period 2013-2019. The first national NHS PBT centre began accepting referrals in October 2018, hence this time period was divided into pre-NHS PBT and post-NHS PBT.
Results:
For the seven most common PBT cancer indications, the total number of newly diagnosed patients was 1686 before NHS PBT and 381 after NHS PBT. The number of treated patients was 479 in the pre-NHS PBT era and 180 afterwards. Overall, the PUP in England grew post-NHS PBT by 66%. More specifically, there is an increase in the PUP between the pre-NHS and post-NHS PBT for any diagnostic category and age group analysed. Among the diagnostic categories analysed, the greatest increase is seen in Medulloblastoma, which became a commissioned indication for PBT in 2016. By age group, post-NHS PBT the most noticeable increase is seen for the age group 16-24.
Conclusion:
Promoting equal access to cutting-edge radiation technology is central to NHS England's core values. The PUP has expanded since the establishment of a National PBT service in England, which employs a central web-based Proton Referral Pathway overseen by a National Proton Office. Further investigation will be conducted to determine whether socioeconomic or geographic barriers exist between different areas.
