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Gaito S, Aznar MC, Burnet NG, Crellin A, France A, Indelicato D, Kirkby KJ, Pan S, Whitfield G, Smith E. Assessing Equity of Access to Proton Beam Therapy: A Literature Review. Clin Oncol (R Coll Radiol) 2023; 35:e528-e536. [PMID: 37296036 DOI: 10.1016/j.clon.2023.05.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023]
Abstract
Proton beam therapy (PBT) is one of the most advanced radiotherapy technologies, with growing evidence to support its use in specific clinical scenarios and exponential growth of demand and capacity worldwide over the past few decades. However, geographical inequalities persist in the distribution of PBT centres, which translate into variations in access and use of this technology. The aim of this work was to look at the factors that contribute to these inequalities, to help raise awareness among stakeholders, governments and policy makers. A literature search was conducted using the Population, Intervention, Comparison, Outcomes (PICO) criteria. The same search strategy was run in Embase and Medline and identified 242 records, which were screened for manual review. Of these, 24 were deemed relevant and were included in this analysis. Most of the 24 publications included in this review originated from the USA (22/24) and involved paediatric patients, teenagers and young adults (61% for children and/or teenagers and young adults versus 39% for adults). The most reported indicator of disparity was socioeconomic status (16/24), followed by geographical location (13/24). All the studies evaluated in this review showed disparities in the access to PBT. As paediatric patients make up a significant proportion of the PBT-eligible patients, equity of access to PBT also raises ethical considerations. Therefore, further research is needed into the equity of access to PBT to reduce the care gap.
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Affiliation(s)
- S Gaito
- Proton Clinical Outcomes Unit, The Christie NHS Proton Beam Therapy Centre, Manchester, UK; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK; Department of Proton Beam Therapy, The Christie Proton Beam Therapy Centre, Manchester, UK.
| | - M C Aznar
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - N G Burnet
- Department of Proton Beam Therapy, The Christie Proton Beam Therapy Centre, Manchester, UK
| | - A Crellin
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK; National Lead Proton Beam Therapy NHS England, UK
| | - A France
- Proton Clinical Outcomes Unit, The Christie NHS Proton Beam Therapy Centre, Manchester, UK
| | - D Indelicato
- Department of Radiation Oncology, University of Florida, Jacksonville, Florida, USA
| | - K J Kirkby
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK; Department of Proton Beam Therapy, The Christie Proton Beam Therapy Centre, Manchester, UK
| | - S Pan
- Department of Proton Beam Therapy, The Christie Proton Beam Therapy Centre, Manchester, UK
| | - G Whitfield
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK; Department of Proton Beam Therapy, The Christie Proton Beam Therapy Centre, Manchester, UK
| | - E Smith
- Proton Clinical Outcomes Unit, The Christie NHS Proton Beam Therapy Centre, Manchester, UK; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK; Department of Proton Beam Therapy, The Christie Proton Beam Therapy Centre, Manchester, UK
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