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PROTON FACILITIES. Present situation. Due to the comprehensive cancer centers with multidisciplinary meetings with experts from university centers, the quality of the oncological treatment in every hospital could be guaranteed Almost all patients are discussed in multidisciplinary meetings.

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present situation
Present situation
  • Due to the comprehensive cancer centers with multidisciplinary meetings with experts from university centers, the quality of the oncological treatment in every hospital could be guaranteed
  • Almost all patients are discussed in multidisciplinary meetings

J.W.H. Leer MD PhD

slide4

It is proven that the survival of patients, whose treatment is decided on and carried out by a multidisciplinary team, is improved

J.W.H. Leer MD PhD

new developments
New developments
  • Subspecialization
  • Increased complexity of mostly multidisciplinary treatments
  • Larger hospitals with a possibility of subspecialization in non-academic centers

J.W.H. Leer MD PhD

new developments6
New developments
  • Increase in tumour specific multidisciplinary meetings
  • Subspecialization within the departments
  • Consequences for the size of the staff, the department and the population to be served

J.W.H. Leer MD PhD

slide7

Almost all treatments are multidisciplinary

  • Most treatments are very complex
  • The quality of care depends on the organization and the cohesion of the multidisciplinary team

J.W.H. Leer MD PhD

some believe that consequently all cancer care should be concentrated in a few centers
Some believe that consequently all cancer care should be concentrated in a few centers

J.W.H. Leer MD PhD

slide9

The answer to the need to concentrate high complexity care and to deliver high qualitybasic cancer care near to the patient is the creation of:

  • Oncologicalnetworks

J.W.H. Leer MD PhD

umc st radboud has chosen to create a network with members and partners in oncology
UMC St Radboud has chosen to create a network with members and partners in oncology

J.W.H. Leer MD PhD

slide11
Smaller hospitals are partners.Protocols are similar and the academic hospital has a responsibility for the delivered care.

J.W.H. Leer MD PhD

slide12
Larger hospitals are members, but also agree on common protocols. However, the academic center does not have a direct responsibility.

J.W.H. Leer MD PhD

slide13
In both relations protocols are harmonized and an audit system is in place to guarantee the quality of oncological care.

J.W.H. Leer MD PhD

slide14

Only a very selective kind of oncological care should be concentrated nationally. Mostly rare diseases or treatments that request a very specialized skill or infrastructure .

Is this the case for proton therapy ??

Is the number of patients whose treatment should be centralized important ??

J.W.H. Leer MD PhD

who will benefit from proton therapy
Who will benefit from proton therapy
  • Standard indications (0,6%)
  • Potential indications (3%)
  • Model based indications (12%)
  • Reducing the risk of secondary tumors (2%)

______

(17,6%)

J.W.H. Leer MD PhD

slide16

If proton therapy is better than photon therapy and we have the means to provide it, it should be offered to our patients.

However,

J.W.H. Leer MD PhD

slide17

Concentration of a part of the multidisciplinary treatment in a very few centers might be a solution for economical reasons, but is a less attractive solution from an oncological point of view.

J.W.H. Leer MD PhD

slide18

To concentrate proton therapy in 2-3 centers in the Netherlands is unattractive, because it will disrupt the structure of oncological teams and networks.

J.W.H. Leer MD PhD

slide19

The gain should be clinically relevant

  • The gain should outweigh the loss of quality by breaking up the multidisciplinary teams and the whole of the organisation of oncology in our country

J.W.H. Leer MD PhD

slide20

As a concept, tomoproton therapy is more attractive because it will not necessarily change the oncological structure in a country. The major question is: Will it work.

J.W.H. Leer MD PhD

why is the radboud interested in tomoproton therapy
Why is the Radboud interested in tomoproton therapy?
  • We want to contribute to evaluate the advantages of proton therapy

J.W.H. Leer MD PhD

why is the radboud interested in tomoproton therapy22
Why is the Radboud interested in tomoproton therapy?
  • We support the idea to introduce a new technology, without breaking up established oncological collaborations

J.W.H. Leer MD PhD

i do not believe that randomized clinical trials will provide an answer
I do not believe that randomized clinical trials will provide an answer
  • Prospective cohort studies comparing protons and photons with strict protocols by a collaborative group are more likely to be successful

J.W.H. Leer MD PhD

slide24

We need to find grant money to support the datamanagement and quality control

J.W.H. Leer MD PhD

slide25

We have the experience of conducting clinical and biological studies and seek collaboration with UMC Groningen and technical university Twente and others

J.W.H. Leer MD PhD

slide26

We envisage a collaboration of all radiotherapy centers in northeast Holland to conduct the prospective clinical studies

J.W.H. Leer MD PhD

slide27

THANK YOU

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