ESTRO 2025 - Abstract Book

S2368

Interdisciplinary – Other

ESTRO 2025

2007

Digital Poster Enhancing referral rates to proton therapy in the Netherlands: an action research approach Fiona Ho 1 , Luca Heising 1,2 , Evelien Backx 1 , Judith van Loon 1 , Liesbeth Boersma 1 , Maria Jacobs 2 1 Department of Radiation Oncology (Maastro), GROW Research Institute for Oncology and Reproduction, Maastricht University Medical Centre+, Maastro, Maastricht, Netherlands. 2 Tilburg School of Economics and Management, Tilburg University, Tilburg, Netherlands Purpose/Objective Proton therapy (PT) is described as a radical innovation for potentially enhanced treatment precision and reduced adverse effects compared to conventional photon therapy (1). Despite these anticipated benefits and nationally established referral guidelines, research has shown that a large portion of eligible patients are not referred for PT. This study, conducted in the Netherlands, aims to identify factors contributing to the suboptimal referrals of eligible lung and oesophageal cancer patients for PT and to develop strategies for improvement using an action research approach. Material/Methods This study involved two referring radiotherapy centres and adopted an action research method. In the first phase (1-diagnosis; Q1-Q2 2022), interviews with patients, patient’ representatives and medical specialists, along with workshops with medical specialists were conducted to map the current care pathway/annex patient journey. For the second phase (2-action planning; Q2-Q4 2022), a comprehensive plan for process improvements and pilot testing was developed, followed by implementing the interventions (3-action taking; 2023). The intervention outcomes were then evaluated (4-assessment; 2024) and reflected upon (5-learning; 2024). Key endpoints included the number of referrals, lead times, and patient satisfaction. interorganisational patient journey, gaps in knowledge and experience, and insufficient support and evidence for scaling up PT. To address these issues, the targeted interventions that were planned and executed aimed at optimising the patient journey, improving communication, and strengthening relationship management. These efforts resulted in a significant increase in referrals for lung (p=0.02) and oesophageal cancer patients (p=0.04) (Figure 1). Furthermore, opt-outs for lung cancer patients increased (p=0.02) at referring hospital 1 over two years. These outcomes were not observed at referring hospital 2. Additional analysis revealed that the targeted interventions did not extend lead times for either referring hospital. The number of patients who reported being extremely satisfied (rated on a scale from 1-5) increased by 33% for all treated PT patients. Results Based on the diagnosis phase, access to PT in the Netherlands encountered challenges related to the