UK to spend £250m on proton beam treatment despite no appraisal by NICE

BMJ 2012; 344 doi: (Published 10 April 2012) Cite this as: BMJ 2012;344:e2627
  1. Nigel Hawkes
  1. 1London

The NHS is to spend up to £250m (€303m; $396m) to build two centres for proton beam therapy for cancer, the health secretary announced on 5 April.

The machines, which deliver high energy beams of subatomic particles, will be built at the Christie NHS Foundation Trust in Manchester and at University College Hospitals London NHS Foundation Trust, and the Department of Health said they would benefit around 1500 patients a year.

The treatment is complex and costly, and will not be fully available in England until 2017. Until then, the NHS will continue to fund the treatment abroad of those deemed suitable, which includes some children with cancer.

In 2007 the National Radiotherapy Advisory Group recommended that “at least one modern proton facility” should be set up in England, sited appropriately to allow access to patients from Scotland, Wales, and Northern Ireland. It estimated that the need for the treatment was around 400 patients a year ( Today’s decision derives from that recommendation.

Adrian Crellin, dean of clinical oncology at the Royal College of Radiologists, said: “Proton treatment will be of benefit to patients with certain rare cancers. It will offer significantly better outcomes in curing cancer in children and some adult cancers of the skull and spine. It builds on the already successful NHS programme to send some patients abroad for this treatment.”

However, proton beam therapy has not been the subject of a technology appraisal by the National Institute for Health and Clinical Excellence, so it is not yet clear that its cost could not have achieved greater benefits if applied elsewhere in the NHS, either in cancer treatment or in other areas.

In 2008 Fergus Macbeth, the then director of the Centre for Clinical Practice at NICE, commented in the Journal of Clinical Oncology (doi:10.1200/JCO.2008.16.5514) that there was no reliable, objective evidence that proton beam treatment improved clinical outcomes, either survival or quality of life, and the only tumours for which there was any evidence of benefit were base of skull cordomas and ocular tumours.

The health secretary, Andrew Lansley, had no doubts. “Developing a national proton beam therapy service is vital to ensuring our cancer facilities are world-class. We have always said that it is patient outcomes which matter and to get the best for patients we must always be looking to push the boundaries.

“In addition to improved success rates proton beam therapy reduces the side effects which patients, particularly children, can suffer as a result of traditional forms of cancer treatment.”

The charity Cancer Research UK also welcomed the decision. Its chief clinician, Peter Johnson, said: “Proton beam therapy has important benefits over conventional radiotherapy for patients with several types of cancer, such as brain tumours in children.

“We want to see improvement to radiotherapy services across the UK, to match the best in the world, and ensure no one misses out on cutting edge treatment. Today’s announcement shows that progress is being made towards achieving that goal.”

The Department of Health said that the plan was “affordable and deliverable.” If further capacity should be needed in future, the preferred site would be University Hospitals Birmingham.


Cite this as: BMJ 2012;344:e2627