Skip to main content

Main menu

  • Home
  • COVID-19
    • Articles & podcasts
    • Blog posts
    • Collection
    • News
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • Classified ads
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
    • Career Ad Discount
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • COVID-19
    • Articles & podcasts
    • Blog posts
    • Collection
    • News
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • Classified ads
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
    • Career Ad Discount
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Pinterest
  • Follow CMAJ on Youtube
  • Follow CMAJ on Instagram
Practice

Proton beam therapy for cancer

Derek S. Tsang and Samir Patel
CMAJ June 17, 2019 191 (24) E664-E666; DOI: https://doi.org/10.1503/cmaj.190008
Derek S. Tsang
Radiation Medicine Program (Tsang), Princess Margaret Cancer Centre, University Health Network; Division of Haematology/Oncology (Tsang), Hospital for Sick Children, Toronto, Ont.; Divisions of Radiation Oncology and Pediatric Oncology (Patel), Cross Cancer Institute and Stollery Children’s Hospital, University of Alberta, Edmonton, Alta.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Samir Patel
Radiation Medicine Program (Tsang), Princess Margaret Cancer Centre, University Health Network; Division of Haematology/Oncology (Tsang), Hospital for Sick Children, Toronto, Ont.; Divisions of Radiation Oncology and Pediatric Oncology (Patel), Cross Cancer Institute and Stollery Children’s Hospital, University of Alberta, Edmonton, Alta.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Tables
  • Related Content
  • Responses
  • Metrics
  • PDF
Loading
Submit a Response to This Article
Compose Response

More information about text formats

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
References
Author Information
First or given name, e.g. 'Peter'.
Your last, or family, name, e.g. 'MacMoody'.
Your email address, e.g. higgs-boson@gmail.com
Your role and/or occupation, e.g. 'Orthopedic Surgeon'. Minimum 7 characters.
Your organization or institution (if applicable), e.g. 'Royal Free Hospital'. Minimum 12 characters.
Your organization, institution's or residential address.
Statement of Competing Interests

Vertical Tabs

Jump to comment:

  • Proton beam therapy should remain in the public domain
    Tarek Hijal, Carolyn R Freeman and Jan Seuntjens
    Posted on: 14 August 2019
  • Posted on: (14 August 2019)
    Proton beam therapy should remain in the public domain
    • Tarek Hijal, Director, Division of Radiation Oncology, McGill University Health Centre
    • Other Contributors:
      • Carolyn R Freeman, Radiation Oncologist
      • Jan Seuntjens, Director, Medical Physics Unit

    We would like to respond to the article “Proton beam therapy for cancer” by Tsang and Patel that was published recently in the CMAJ (CMAJ 2019 June 17;191:E664-6. doi: 10.1503/cmaj.190008).

    As the authors state, radiotherapy is a critical element of treatment for one third to one half of all patients with cancer. Over the past two decades, there have been significant improvements in the way radiotherapy is delivered, one of the most important being proton beam therapy that allows greater sparing of normal tissue adjacent to the tumour as compared with other forms of radiotherapy. This is especially important for young children and adults whose overall survival is currently in Canada >80% and who are particularly vulnerable to potentially devastating long-term effects of treatment. Currently, no proton beam facility exists in Canada and patients deemed eligible receive this therapy at proton centres in the United States at a cost often exceeding $250,000 per patient, paid for by the provincial health plans. In Quebec there is a well-established process for referral for treatment with proton therapy in the United States but even so the number of children and young adults that currently benefit from this treatment is lower than expected: some are simply not well enough, for example after major operations, to travel while for others there may be important practical considerations.

    As Tsang and Patel mention, a private corporation has recently expressed an in...

    Show More

    We would like to respond to the article “Proton beam therapy for cancer” by Tsang and Patel that was published recently in the CMAJ (CMAJ 2019 June 17;191:E664-6. doi: 10.1503/cmaj.190008).

    As the authors state, radiotherapy is a critical element of treatment for one third to one half of all patients with cancer. Over the past two decades, there have been significant improvements in the way radiotherapy is delivered, one of the most important being proton beam therapy that allows greater sparing of normal tissue adjacent to the tumour as compared with other forms of radiotherapy. This is especially important for young children and adults whose overall survival is currently in Canada >80% and who are particularly vulnerable to potentially devastating long-term effects of treatment. Currently, no proton beam facility exists in Canada and patients deemed eligible receive this therapy at proton centres in the United States at a cost often exceeding $250,000 per patient, paid for by the provincial health plans. In Quebec there is a well-established process for referral for treatment with proton therapy in the United States but even so the number of children and young adults that currently benefit from this treatment is lower than expected: some are simply not well enough, for example after major operations, to travel while for others there may be important practical considerations.

    As Tsang and Patel mention, a private corporation has recently expressed an interest in building a stand-alone proton therapy facility in Montreal. For several reasons it is our opinion that developing proton therapy as a standalone private initiative is wrong.

    Perhaps most importantly it introduces major risks for the patients. Most children below the age of 5-7 – a substantial proportion of all children and teenagers with cancer who require radiotherapy - will need to undergo treatments under anesthesia. A serious complication away from the support of a pediatric care facility would be potentially devastating. As well, since radiation therapy is part of a multidisciplinary cancer treatment strategy that in pediatric practice almost always combines surgery and chemotherapy and requires intensive supportive care, it is highly preferable that proton therapy be geographically embedded in a multidisciplinary environment that can provide this type of complete care. Such an environment also provides the university - healthcare setting needed for cutting edge research and technology development and provides professional training programs critical around this type of technology. In comparable economies such as the Netherlands, France and others, all recent proton centres have been embedded in an existing hospital settings.

    Lastly, a privately owned and operated facility lacks economic sense. Although each treatment would be 40-50% cheaper than sending patients to the USA, the proposal estimates a cost of more than $100,000 per patient. A public facility could decrease that cost to $20,000, saving some $10,000,000 per year for our provincial health system. Moreover as the use of protons expands, the total cost of treating patients in a private facility would only increase.

    In a public health system, operating an expensive and cutting-edge facility in the private sector goes against all convention. It makes no sense financially, logistically or academically and is potentially dangerous for the very patients who stand to benefit most. Proton therapy should remain in the public domain.

    Show Less
    Competing Interests: None declared.
PreviousNext
Back to top

In this issue

Canadian Medical Association Journal: 191 (24)
CMAJ
Vol. 191, Issue 24
17 Jun 2019
  • Table of Contents
  • Index by author

Article tools

Respond to this article
Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Proton beam therapy for cancer
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Proton beam therapy for cancer
Derek S. Tsang, Samir Patel
CMAJ Jun 2019, 191 (24) E664-E666; DOI: 10.1503/cmaj.190008

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
Proton beam therapy for cancer
Derek S. Tsang, Samir Patel
CMAJ Jun 2019, 191 (24) E664-E666; DOI: 10.1503/cmaj.190008
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • What is proton beam therapy?
    • How is proton therapy delivered?
    • Who is eligible for proton therapy?
    • What are the harms?
    • What is the evidence so far?
    • What can be expected in the future?
    • Acknowledgements
    • Footnotes
    • References
  • Figures & Tables
  • Related Content
  • Responses
  • Metrics
  • PDF

Related Articles

  • Proton beam therapy should remain in the public domain
  • PubMed
  • Google Scholar

Cited By...

  • Proton beam therapy should remain in the public domain
  • Google Scholar

More in this TOC Section

  • Azathioprine-induced severe anemia potentiated by the concurrent use of allopurinol
  • Schwannoma of the tongue
  • “Superscan” in diffusion-weighted imaging with background body suppression magnetic resonance imaging
Show more Practice

Similar Articles

Collections

  • Sections
    • Innovations
  • Topics
    • Radiation therapy
    • Pediatrics
    • Cancer & oncology

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions

Copyright 2021, Joule Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

Powered by HighWire