Addressing Travel-Time Disparities in Proton Beam Therapy Access

A recent study published in JAMA Network Open highlights significant disparities in travel-time access to proton beam therapy (PBT) for cancer treatment across the contiguous United States. Proton beam therapy, an advanced form of radiotherapy, offers potential benefits over traditional photon-based therapy, including reduced radiation exposure to surrounding healthy tissues. However, the high cost and limited number of PBT facilities result in unequal access, particularly affecting certain population subgroups.

Key Findings

Population Coverage: The study analyzed travel times for 327.5 million US residents. More than 60% live more than a one-hour drive from a PBT facility, while 16.4% face a commute of four hours or more. The median drive time to a proton center was 96.1 minutes.

At-Risk Groups: Those most affected by long travel times include individuals aged 65 and older, those living below the federal poverty line, and residents of suburban and rural areas.

Impact of Rurality and Poverty: Multivariable analysis showed that rural residents are 2.45 times more likely to have long commutes, while those living below the poverty line are 1.22 times more likely.

Implications

The study’s findings underscore the geographic and socioeconomic barriers to accessing PBT, which may hinder participation in clinical trials and equitable treatment outcomes. Long travel times can discourage patients from seeking this advanced therapy, exacerbating health disparities. Older adults and low-income individuals are particularly disadvantaged, facing significant challenges in accessing necessary cancer treatments.

NAPT’s Perspective on Improving Access

The National Association for Proton Therapy is dedicated to enhancing patient access to PBT, recognizing that geographic and socioeconomic barriers must be addressed to ensure equitable treatment opportunities. Although the number of proton centers has doubled in the last 10 years, there are key areas of the US that are proton deserts with very limited access to this advanced technology. NAPT advocates for:

• Increased Facility Distribution: Expanding the number and geographic spread of PBT facilities to ensure more Americans can access this advanced cancer treatment without undue travel burdens.
• Support Services: Enhancing support services such as travel assistance, temporary lodging, and patient navigation programs to help those who need to travel long distances for treatment. NAPT applauds the recent CMS decision to include reimbursement for navigation services under the Medicare Physician Fee Schedule (MPFS). More information here: CMS Physician Payment Rule Advances Health Equity | CMS.
• Policy Advocacy: Working with policymakers to develop initiatives and funding mechanisms that support the establishment of PBT centers in underserved regions, and advocating for insurance coverage policies that reduce the financial burden on patients.
  It is vital to promote the growth of advanced radiation oncology techniques such as proton therapy by supporting research and the development of well-designed payment models that do not inadvertently hinder future advancements in this field.
• Research and Education: Promoting research to understand and address the barriers to access, and educating healthcare providers and patients about the benefits of proton therapy and the available support services. NAPT is committed to encouraging accessibility and participation in research trials that add to the industry’s body of clinical knowledge regarding the benefits of proton therapy.

NAPT believes that by addressing these access issues, we can improve cancer treatment outcomes and ensure that all patients, regardless of their geographic location or socioeconomic status, have the opportunity to benefit from proton therapy.

Related Upcoming Event:

NAPT, in partnership with the American Cancer Society (ACS), is hosting a webinar in August to highlight the patient navigation assistance offered through the The American Cancer Society Leadership in Oncology Navigation (ACS LION) Program. This program provides critical support to patients facing geographic and financial barriers to accessing proton therapy. Join us for this important discussion to learn more about how we can work together to improve access to life-saving cancer treatments.