Referring Patients Abroad for Proton Therapy

Abstract

A working party of the Royal College of Radiologists has produced a report, published in this edition, about proton therapy for base of skull chordoma and other uncommon malignancies. There is a proton facility in the UK, at Clatterbridge, which is suitable for treatment of superficial tumours, such as ocular melanoma. Patients with deep-seated tumours for whom the treatment of choice is protons would therefore need to be referred to a facility abroad. This editorial briefly sets out the procedure for making such a referral for proton therapy, but it is generically applicable to treatment abroad for any condition. The procedure differs according to whether the patient is referred to a hospital inside or outside the European Economic Area (EEA). Countries to which UK patients have been referred for proton therapy are France, which is within the EEA and the USA, outside the EEA. As with any treatment, the first step is for the consultant clinical oncologist, in consultation with other doctors involved and the patient, to reach a decision that proton therapy is appropriate. This will require full explanation to the patient of the added complication of having to go abroad for treatment. In these special circumstances agreement from the patient’s health authority (HA) will be required for the proposed treatment, since the treatment will be expensive and the HA will fund it. It would be prudent to consult the HA at an early stage, perhaps before the doctor and patient have reached a decision to have proton therapy. The consultant clinical oncologist will need to consult his or her counterparts at one or more proton facilities abroad, in order to decide to which centre the patient should be referred. The clinical oncologist then needs to present an evidence-based case to the HA that the patient should be referred to a specific proton facility abroad. The HA will expect the case to be made by a clinical oncologist because the treatment is radiotherapy, rather than by the patient’s neurosurgeon, who does not prescribe radiotherapy. Similarly, the clinical oncologist at the proton facility