Skip to main content

Main menu

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 Articles
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2022
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

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

Advanced Search

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 Articles
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2022
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Pinterest
  • Follow CMAJ on Youtube
  • Follow CMAJ on Instagram

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, McGill University Health Centre
    • Jan Seuntjens, Director, Medical Physics Unit, McGill University
14 August 2019

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.

Competing Interests: None declared.
See article »

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
  • Advisory Panels
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions
  • Accessibiity
  • CMA Civility Standards
CMAJ Group

Copyright 2022, CMA Impact 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.

To receive any of these resources in an accessible format, please contact us at CMAJ Group, 500-1410 Blair Towers Place, Ottawa ON, K1J 9B9; p: 1-888-855-2555; e: cmajgroup@cmaj.ca

Powered by HighWire