Proton therapy in Poland: wasted potential of the innovative treatment method

Approx. 170 thousand new cases of cancers are diagnosed, with an estimated 100 thousand deaths. One of key cancer treatment methods is radiotherapy. Its state-of-the-art-variety is proton therapy -  an advanced technology using precise proton radiation to destroy cancerous tumors. Its advantage is the very high precision of the radiation beam reaching the tumor. This method makes it possible to better control the cancer locally and reduces the risk of complications, which is particularly important in case of deep-seated cancers, e.g. intracranial tumours.

The only proton therapy facility in Poland is the Institute of Nuclear Physics Polish Academy of Sciences in Kraków, which includes the Cyclotron Centre Bronowice (CCB). It has two gantry machines at its disposal, designed for the proton therapy for cancers other than eye cancers and one gantry machine for the proton therapy specifically of the eye cancer. Since CCB is not a medical institution, the proton therapy in this facility is carried out in line with agreements signed by the service providers, i.e.  the National Oncology Institute (NIO), Branch in Kraków (other than eye cancers) and the University Hospital in Kraków (eye cancers).

Already in 2020 NIK investigated the availability of proton therapy and use of cyclotrons at the Cyclotron Centre Bronowice. The audit revealed that the facility uses only 30% of its therapeutic potential. Besides, the proton therapy for children was stopped and no strategy for developing this treatment method was prepared.

No strategy and no system solutions

NIK stands in a position that efforts of subsequent ministers of health were not sufficient to develop and structure the proton therapy system in Poland. Although the list of cancers to be treated with this method was extended in 2023, the potential of the Cyclotron Centre Bronowice was not fully used.

From the facility opening until the end of 2023, a significant rise in the number of patients subject to the proton therapy for cancers other than eye cancers was observed. The therapeutic potential of gantry machines at CCB was not fully used, though. 312 patients were subject to the proton therapy in 2023, which represented 78% of the CCB’s total treatment capacity.

In 2019, the Minister of Health appointed a team to develop a long-term strategy for proton therapy development in Poland covering system solutions. After four and a half years, the strategy was not ready yet, though.

In 2020–2024, the Minister commissioned the Agency for Health Technology Assessment and Tariff System (AOTMiT) to prepare new tariffs for proton therapy for cancers other than eye cancers. Referring to NIK’s report of 2020, the President of AOTMiT underlined that the change in tariffs alone - although needed - will not improve the patients' access to the proton therapy. The reason is that to reduce the costs of treatment and increase its availability, changes are needed in the organisation of services and better cooperation between the Cyclotron Centre Bronowice and medical facilities.

Organisational problems with children’s treatment

Ineffective efforts of the Minister of Health resulted in limiting access to the proton therapy. Also, numerous organisational problems and the lack of cooperation between the facilities made the patients’ treatment more difficult.

In 2019-2022, NIO did not provide the proton therapy for children with cancers other than eye cancers. In May 2022, the therapy was renewed but it did not cover pediatric patients requiring general anaesthesia. Therefore, those children’s families were forced to look for treatment abroad. As a consequence, the state budget funds of about PLN 6 million were transferred to the foreign healthcare system. NIK has also noted that the anaesthetic and medical equipment worth approx. PLN 1 million was not in use because the proton therapy procedures were not conducted with children under general anaesthesia at CCB. It means that the available resources were not managed efficiently. From the proton therapy renewal in May 2022 until May 2024, the total of 74 children took advantage of that treatment method.

In 2020-2024, the Minister of Health expanded the list of indications for proton therapy other than eye cancers. As a result, the number of patients in therapy whose diseases were on the list of guaranteed services increased from 107 in 2022 to 206 in 2023.

However, among all patients undergoing proton therapy from 2020 to 2024 (8 May), over 34% were persons whose diseases were not covered by the list of guaranteed services, and the consent for their treatment was issued by the National Consultant in the field of radiation oncology. If the proton therapy were limited only to patients from the list of indications of the Ministry of Health, in 2023 the use of the CCB’s annual therapeutic potential (400 patients) would be just over 50%.

Recommendations

To the Minister of Health to:

• develop rules (separate for adult and child patients) of the proton therapy organisation, considering the option of singing contracts with service providers nationwide;
• update the proton therapy tariffs for cancers other than eye cancers, taking into account separate rates for adults and children, including children requiring general anesthesia during the therapy;
• develop systemic solutions enabling the establishment of a treatment centre at the Cyclotron Centre Bronowice in Kraków. This initiative should be implemented in cooperation with the following bodies: Prime Minister, Minister of Science, Directorate of the Institute of Nuclear Physics Polish Academy of Sciences in Kraków, President of the National Health Fund, medical entities dealing with oncology and National Consultant for Radiation Oncology.