Proton Therapy Congress 2016
Practical implementation of proton therapy in the UK
Prof Karol Sikora - Proton Partners International, Cardiff, UK
The conference is all about the role of protons in radiotherapy, very controversial. Some people believe only 1% of radiotherapy should be delivered by protons, others think 40%, the truth is somewhere in between, I think about 10%.
Are you holding a discussion at the conference?
I am, I’m sharing that, particularly about the UK. Here we have a very peculiar system in that we’ve got two units being built by our NHS, the government health service which covers 90% of the population, and five being built by our organisation which is a private organisation with private sector finance from the City. Really the whole question is what percentage of patients having radical radiotherapy, radiotherapy for cure, would be better off having protons and it’s fascinating to see. The range is enormous but my own feeling is 10% and therefore we need something like 18 machines in this country. The same calculations apply right across Europe and in fact round the world.
Money seems to be a big issue in proton therapy.
That’s the problem. If protons were the same price as photons, linear accelerators that generate photons, there’d be no argument. We’d still be here having a Proton Congress but there would be no financial argument. Of course it’s not just radiotherapy, there are high cost initiatives in pharmaceuticals, as you know, some of the cancer drugs now are costing more than $120,000 a year. All healthcare systems are struggling, cancer is predominantly a disease of older people and the question is how much can younger people paying tax in countries like this support older people who are paying less tax to have very cost interventions that may only be partially successful.
How do you see the NHS vs private divide affecting access to care or the building of centres?
It’s a combination of both physical building, having the capital, and also having the running costs and also, with high cost drugs, actually obtaining the drugs. The problem of the NHS at the moment it is really short of money, it is bust basically, and I think we all agree, even the politicians agree. There’s no simple solution, you can’t just shovel another few billion pounds into it because where does that come from – roads, teaching, education, all sorts of other things you’d have to cut? So the NHS is, of course, the religion of the British society but I’m afraid we’ve got to have some radical solutions for it.
When do you see the debate of proton vs photon being settled?
I think within the next two years. If you look at how the world of protons globally are going a lot of clinical data will come forward in the next three years. So by 2020 I think we’ll be in a position to really evaluate at what percentage we want in terms of radical radiotherapy. I think it will be consistent throughout the world, the NHS is an outlier at the moment but I think it will come into line, the UK will come into line with western Europe. We’ll always lag behind the Americans who are always over-ambitious and over-enthusiastic with innovation and that’s always been the way and that’s fair enough. But I think by 2020 it will all settle down.
