ESTRO 2022 - Abstract Book

S35

Abstract book

ESTRO 2022

Conclusion The pCSI infrastructure for pediatric MB patients, integrated within the national pediatric oncology center, facilitated a timely start of treatment in over 90% of patients. For adult patients, post-surgical condition is a common reason for delayed start of treatment. During pCSI treatment, a well-orchestrated interplay between several (para)medical disciplines is required to provide all potential necessary care. We were able to deliver pCSI treatment with less than 3 days interruption to in 98% of patients.

MO-0062 Clues to address barriers for access to proton therapy in the Netherlands

S. Thijssen 1 , L.J. Boersma 1 , C. Roumen 1 , M.J. Jacobs 2

1 Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, The Netherlands, Radiotherapy, Maastricht, The Netherlands; 2 Tilburg School of Economics and Management, Tilburg University, Tilburg, The Netherlands, Economics and management, Tilburg, The Netherlands Purpose or Objective Proton therapy (PT) is a form of radiotherapy which yields less dose to normal tissues than the routinely used photon therapy. Despite the presence of National Indication Protocols on PT, based upon which patients can be selected who benefit most from PT, the capacity of Proton Therapy Centres (PTCs) is still underused. The objective of this research is to find clues to solve barriers for access to PT in the Netherlands. Materials and Methods We conducted a nation-wide survey, semi-structured interviews with professionals and patients, and 4 workshops. The survey was sent out to all 330 members of the Dutch Society for Radiation Oncology (NVRO) [Thijssen et al, PTCOG 2021, poster #PTC59-2112]. Thereafter, semi-structured, in-depth interview questions were conducted with (N = 6) radiation oncologists (ROs) and (N = 4) patients, based on the outcomes of the survey. The interviews were recorded, transcribed via Word Dictate, and coded manually. Finally, co-creation workshops (2 for esophageal and 2 for lung cancer) were conducted based upon co-creation and multi-disciplinary ideation, with 3 ROs from the PTC and 3-5 ROs from the four hospitals referring to our PTC, aimed at redefining the care-paths for esophageal and lung cancer. The resulting input from these workshops was analyzed using open coding. Results The most prominent barriers mentioned in the survey (patient's choice, logistics and perceived insufficient relative advantage), were confirmed in the in-depth interviews: the administrative burden and delay in treatment, the practical usability and lack of scientific evidence of the model-based approach, travel time, knowledge and attitudes about PT, lack of information to patients were prominently mentioned. From the patient interviews, the main identified barriers were the inefficient coordination between the referring centre and the PTC, the communication on the care-pathway, the (arrangement of) travel and discomfort during treatment. During the workshops, the pains and gains were similar as mentioned above; the referring ROs raised awareness amongst the ROs of the PTC with respect to the three main barriers in the care-path 1) patient selection 2) delay and 3) worries about the combination with chemotherapy. Ideas to solve these barriers were jointly generated, and consisted with additional clues for patient selection, several innovative ways to enhance referral, in combination with the advice to appoint a case-manager. In addition, the necessity for a multidisciplinary approach, with medical oncologists, surgeons and pulmonologists was brought under the attention of the ROs of the PTC. Conclusion Based on the outcomes of the previous survey and this research, we can conclude that the three most important clues to improve access to PT in the Netherlands, consist of additive aids for patient selection, innovative approaches to solve delay and logistics, and a multi-disciplinary approach, especially in case of concurrent chemotherapy.

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