First Pan-Canadian Consensus Recommendations for Proton Beam Therapy Access in Canada

Purpose/Objective(s) Proton Beam Therapy (PBT) is a useful treatment option for select cancer patients, however clinical evidence is quickly evolving, and clinical and health system challenges impede consistent access to this treatment in Canada. The purpose of this initiative was to facilitate consistent and equitable PBT access for appropriate patients through the creation of a pan-Canadian PBT access consensus recommendations document. Materials/Methods A modified Delphi process was used to develop pan-Canadian recommendations with input from provincial PBT clinical and administrative experts, provincial cancer and system partners, and feedback from a targeted community consultation. This was conducted by electronic survey and live discussion. Consensus threshold was set at 70% agreement. Results Four consensus rounds resulted in a final set of 27 recommendations divided into three requirement categories: patient eligibility (n=9); program level (n=10); and system level (n=8). Patient eligibility included: anatomic site (n=4), patient characteristics (n=3), clinical efficacy (n=2). Program level included: regulatory and staff requirements (n=5), equipment and technologies (n=4), quality assurance (n=1). System level included: referral process (n=5), costing, budget impact and quality adjusted life years (n=2), eligible patient estimates (n=1). It was endorsed by the Canadian Association of Provincial Cancer Agencies and its member organizations in June 2021 and distributed to all 43 cancer programs in Canada. Conclusion The consensus-building approach resulted in an evidence-based suite of recommendations that support application of consistent clinical criteria to inform treatment options, facility set-up and access to high quality care. Annual review will ensure alignment with best practices, emerging evidence, and status of PBT delivery in Canada.