Clues to address barriers for access to proton therapy in the Netherlands
Maria Jacobs,
The Netherlands
MO-0062
Abstract
Clues to address barriers for access to proton therapy in the Netherlands
Authors: Salina Thijssen1, Liesbeth J. Boersma1, Cheryl Roumen1, Maria J.G. Jacobs2
1Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, The Netherlands, Radiotherapy, Maastricht, The Netherlands; 2Tilburg School of Economics and Management, Tilburg University, Tilburg, The Netherlands, Economics and management, Tilburg, The Netherlands
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Purpose or Objective
Proton
therapy (PT) is a form of radiotherapy which yields less dose to normal tissues
than the routinely used photon therapy. Despite the presence of National
Indication Protocols on PT, based upon which patients can be selected who
benefit most from PT, the capacity of Proton Therapy Centres (PTCs) is still underused.
The objective of
this research is to find clues to solve barriers for access to PT in the
Netherlands.
Material and Methods
We conducted a nation-wide survey, semi-structured interviews with professionals and patients, and 4 workshops. The survey was sent out to all 330 members of the Dutch Society for Radiation Oncology (NVRO) [Thijssen et al, PTCOG 2021, poster #PTC59-2112]. Thereafter, semi-structured, in-depth interview questions were conducted
with (N = 6) radiation oncologists (ROs) and (N = 4) patients, based on the
outcomes of the survey. The interviews were recorded, transcribed via Word
Dictate, and coded manually. Finally, co-creation workshops (2 for esophageal and 2
for lung cancer) were conducted based upon co-creation and multi-disciplinary
ideation, with 3 ROs from the PTC and 3-5 ROs from the four hospitals referring
to our PTC, aimed at redefining the care-paths for esophageal and lung cancer. The resulting input from these workshops was analyzed
using open coding.
Results
The
most prominent barriers mentioned in the survey (patient's choice, logistics
and perceived insufficient relative advantage), were confirmed in the in-depth
interviews: the administrative burden and delay in treatment, the
practical usability and lack of scientific evidence of the model-based approach,
travel time, knowledge and attitudes about PT, lack of information to patients were
prominently mentioned. From
the patient interviews, the main identified barriers were the inefficient
coordination between the referring centre and the PTC, the
communication on the care-pathway, the (arrangement of) travel and discomfort
during treatment. During the workshops, the pains and gains were similar
as mentioned above; the referring ROs raised awareness amongst the ROs of the
PTC with respect to the three main barriers in the care-path 1) patient
selection 2) delay and 3) worries about the combination with chemotherapy. Ideas to solve these barriers were jointly generated,
and consisted with additional clues for patient selection, several innovative
ways to enhance referral, in combination with the advice to appoint a
case-manager. In addition, the necessity for a multidisciplinary approach, with medical oncologists, surgeons and pulmonologists was brought under the attention of the ROs of the PTC.
Conclusion
Based on the outcomes of the previous
survey and this research, we can conclude that the three most important clues
to improve access to PT in the Netherlands, consist of additive aids for
patient selection, innovative approaches to solve delay and logistics, and a
multi-disciplinary approach, especially in case of concurrent chemotherapy.