Étude capacité théranostique 2023–2024 – Modélisation sur la base de la RIV-PSMA. Radiothérapie interne vectorisée (RIV), une approche théranostique à laquelle le patient doit avoir accès. Partie II : analyse approfondie

Abstract

This in-depth analysis highlights the issues and perspectives regarding the deployment and optimization of vectorized internal radiotherapy (VIR), based on the VIR-PSMA model, which is the first theranostic modality that changes the scale of clinical management in nuclear medicine. It made it possible to confirm a characterization of health establishments based on their experience and their ability to integrate this new treatment modality into their care offering. Here are 8 key points and recommendations highlighted in the following pages: 1. Current and future reception capacity: “experienced” and “initiated” establishments have the greatest short-term reception capacity, while “medium-term future” and “long-term future” establishments will come, in the medium and long term respectively, strengthen the provision of care. They will be able to strengthen the healthcare offer and the territorial network if the award of a B rating allows them to do so. 2. Discrepancy between capacity and need: a gap is already observed between the number of patients who can be treated and the real needs of patients eligible for VIR-PSMA, even though capacity projections are voluntarily restricted to “experienced” and “initiated” services only (the “future” services in the medium and long term are not to date uniform in obtaining the necessary authorizations). This gap between capacity and need can be considered initially by optimizing the use of existing resources (in particular thanks to available land capacity), which remains mainly limited by the shortage of professionals. Secondly, the granting of authorizations to “future” services will make it possible to complete the system, and in particular to promote the regional distribution of care provision which shows disparities that could be sources of inequitable access to care in France. 3. Clinical pathway and harmonization of practices: the clinical pathway for patients benefiting from a VIR requires harmonization of practices and the making of recommendations by the SFMN (from the assessment of eligibility to post-dose monitoring, including the organization of treatments and the reception of patients). 4. Training and recruitment needs: the anticipated growth in demand for VIR requires strengthening teams through the recruitment of all staff involved in the patient's journey, as well as the creation of cooperation protocols between all health professionals by strengthening the initial and continuing training of all professionals involved. 5. Investments and adaptation of infrastructure: significant investments in specialized infrastructure and in the upgrading of “up-and-coming” establishments are necessary to support the increase in VIR-related activity. 6. Define a valuation model allowing these care activities to be sustained while meeting specific constraints in terms of operation, infrastructure, and regulations. 7. Role of regional health agencies (ARS): the ARS play a crucial role in coordinating the deployment of the VIR, requiring adaptation of the offer to local needs and a coherent national policy to face the challenges, particularly in the awarding of B grades, but also by ensuring that the teams of professionals are sufficient and trained and that the service meets logistical and security requirements. 8. Short, medium and long term strategies: to respond to the anticipated saturation of reception capacities, strategic actions are necessary in the short-term (less than 2 years), in the medium-term (less than 5 years), and long-term (more than 5 years), including the structuring of the organization, the expansion of recruitment, the harmonization of practices, and the strengthening of reception capacities.