The UK needs five times the number of specialist cancer treatment centres if it is to keep pace with the rest of Europe, one leading oncologist has warned.
The NHS has invested heavily in proton beam therapy in recent years – a type of radiotherapy that targets tumours with a high degree of accuracy while also reducing harmful side effects.
Last year the NHS’s first proton therapy centre opened at the Christie Hospital in Manchester while a second NHS facility is due to launch at the University College Hospital, London, next year – at a combined cost of £250m.
A private proton therapy centre – the Rutherford Cancer Centre, in Newport, Wales – also began treating patients last year, including those referred by the NHS.
One leading cancer treatment specialist, Dr Jiri Kubes, says that while the new raft of proton therapy provision is encouraging, it’s still ‘lagging well behind’ other European benchmarks.
Dr Kubes, medical director of the Proton Therapy Center in Prague, Czech Republic, said: “There has been an unequivocal trend in the oncology field, where proton beam therapy is replacing standard radiation oncology.
“And the NHS is to be applauded for its commitment to this technology.
“However, we’re currently looking at a situation where there will be three proton therapy centres operational in the UK next year.
“I’d argue that’s simply not enough to service the population who want this treatment. It’s lagging well behind.
“And it will take further investment – either through private initiatives or NHS funds – until the UK is on par with many other countries in Europe.”
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Dr Kubes – who famously treated the UK toddler Ashya King in 2014 – points to the Netherlands as the ‘gold standard’ for proton therapy treatment.
He explains: “While proton therapy is new to the UK, this treatment has been widely available in other countries for a number of years.
“There’s also a big discussion about how many proton therapy centres there should be to service a given population.
“The Netherlands, which operates a statutory health insurance scheme – has 16 million inhabitants and, from my point of view, the best oncology care in Europe, maybe even in the world.
“Based on their analysis, they decided they needed four proton therapy centres, which will treat 11,000 patients annually. There’s a similar system in place here in the Czech Republic.
“The UK, on the other hand, has a population of around 65 million – and has only just opened its first specialist proton treatment centres.
“And to be on par with the Netherlands, the UK – which has a population four times larger – would need around 16 facilities.
“That’s clearly a pipe dream set against NHS budget cuts and where private companies would need to step up to the plate.
“But it highlights the gulf. While there’s cause for much optimism in the UK, it is not optimum.”
There are other cost implications, too, says Dr Kubes.
When complete, the two new centres will each treat up to 750 patients every year.
Other patients, who qualify for NHS proton therapy via the Proton Clinical Reference Panel, will be sent abroad.
A recent Freedom of Information Request undertaken by the Proton Therapy Center in Prague revealed how the NHS approved 737 patients to travel abroad for proton treatment between 2008 and 2018.
Almost three quarters of those referred were children.
In the three years leading to 2016, the NHS spent £41.7m sending 452 patients to the USA, and another £1.7m sending 37 patients to Germany and Switzerland.
Treatment at the Proton Therapy Center in Prague typically costs between £20,000 and £65,000 for adult patients. However, the average cost of proton therapy in the USA is over £88,000.
Dr Kubes adds: “There’s no easy solution here. But the NHS will continue to shoulder a great financial burden to send patients abroad until they can treat them at their own centres in the UK.”
Proton therapy is used to treat a range of cancers, including cancers of the brain, central nervous system, head and neck, prostate and lymphomas.
There are only a handful of facilities in the world able to treat breast cancer, including the Proton Therapy Center in Prague.
Unlike traditional X-ray radiotherapy – such as intensity modulated radiotherapy (IMRT) – proton therapy uses an accelerated ‘pencil beam’ of positively-charged particles, travelling at 100,000 miles per hour, and which is said to target the area with pin-point accuracy and has a better chance of shrinking the tumour.
While X-rays pass all the way through the body, damaging sensitive tissues around and behind the tumour site, proton beam therapy particles stop at the tumour, reducing collateral damage and future ‘secondary’ cancers.
Dr Kubes adds: “While the NHS acknowledges the benefits of Proton Beam Therapy, and is building its own centres, they will still only be able to treat a fraction of those who might benefit from it, while many people will be turned down for the treatment because of the very limited indication criteria.
“There’s still a long way to go before patients in the UK have widespread access to it.”