Patterns of Care and Disparities for Access to Proton Therapy for Pediatric Patients in Alberta (2010-2022)

Abstract

Objectives

Canada is the only G7 nation without a clinical proton therapy (PRT) facility. In 2013, Alberta published guidelines for PRT referral to an out-of-country facility (updated in 2019 and 2023). While the Alberta Ministry of Health covers direct costs of PRT, patients encounter indirect costs. Data from the US National Cancer Database has demonstrated notable socioeconomic (SES) and geographic disparities in the receipt of PRT. This study aimed to analyze trends and disparities in access to PRT in a Canadian province.

Methods

Using the Alberta Health Services (AHS) pediatric database, we identified pediatric patients receiving radiotherapy (RT) between 2010-2022 meeting AHS guidelines for PRT. Patient, clinical, and treatment demographics were extracted from electronic medical record. Postal code data at diagnosis provided community characteristics including household income, employment, education, and distance to the nearest photon therapy (PHT) centre. Univariable and multivariable analysis were performed (sig. p<0.05).

Results

Two hundred and twenty-eight pediatric patients received definitive RT, of those, 35 (15.4%) received PRT. The median age at diagnosis was 9.6 [1-18] and 59.2% were male. On multivariable analysis, patient age, gender, and household income was not associated with receiving PHT (p>0.9, p=0.4, p=0.6). On multivariable analysis, primary tumor site and distance to the nearest PHT were significantly associated with receiving PRT. Patients with a CNS primary were significantly more likely to receive PRT (OR=8.53, 95% CI=3.44-24.7, p<0.001). Patients living >25km to the nearest PHT centre were also more likely to receive PRT (OR=2.48, 95% CI=1.09-5.91, p=0.034). Over the course of years 2010-2022, the proportion of patients receiving PRT were as follows: 0%, 12%, 13%, 29%, 43%, 9%, 18%, 29%,15%, 37%, 35%, 16%, and 23% (mean=17%).

Conclusion

In this cohort of patients, SES disparities were not observed for patients receiving PRT vs PHT. Contrary to other studies, we did not observe an incremental increase in utilization of PRT from 2010-2022 despite guideline revisions. Most patients receiving PRT had CNS tumors and lived >25 km to the nearest PHT centre. As PRT referral is guided by provincial guidelines, further Canadian data is needed.