The brand new UMCG Proton Therapy Center opened its doors in January, after an intensive process of research, planning, funding, public debate and realization. Director Bert-Jan Souman is proud and happy, especially for the first batch of patients. 'Offering people with cancer the best suitable treatment, that's what it's all about.'
Why is this treatment center so important?
'With proton therapy, we can irradiate tumors much more precisely, preventing or limiting damage to healthy tissue. This is especially important for patients in whom there is an increased risk of side effects and long-term consequences. Think children, but also people with difficult-to-treat tumors in the head and neck area. Previously, proton therapy was not available in the Netherlands and these patients had to go abroad, or see what was possible with conventional radiotherapy.'
What are the tradeoffs in a major investment like this?
'The UMCG has been conducting scientific research into the use of protons for more than ten years. We want to be at the forefront when it comes to care and technology, so that patients in the Northern Netherlands also receive the best possible treatment. There is already a lot of evidence for the added value of proton therapy. Based on results abroad and carefully calculated predictions, we believe that this treatment should be available within our oncological care offer.'
Health insurers still had doubts ...
'In conjunction with the eight Dutch university medical centers, the Ministry of Health, Welfare and Sport determined in 2013 that there would be four centers for proton therapy: in Groningen, Delft, Maastricht and Amsterdam. Health insurers questioned the need for this and the question of market forces in healthcare, came to a head: who has the say when it comes to introducing new technology in the medical sector?
Unfortunately, the way this debate was conducted led to delays and unnecessary competition, when we would have made more gains in this whole process with teamwork. But the first center - with us in Groningen - is now a fact and we are proud of it. Clear agreements have been made with the health insurers on the basis of the national regulation on the reimbursement of proton therapy.'
Is proton therapy for everyone?
'This treatment does not have added value for every patient and, moreover, its availability is still limited. This is due to the - through 2020 - set maximum of 2,200 patients per year in the Netherlands, 600 of whom may be treated at our center. Doctors determine on the basis of national indication protocols and calculation models whether therapy with protons is appropriate for a patient. Because we spare the healthy tissue as much as possible with proton treatment, children are an important target group. We are the only center in the Netherlands that will treat children, in collaboration with the Prinses Máxima Center in Utrecht.'
What does this development say about mainstream radiotherapy?
'Radiotherapy as we know it is of great value. Every year, tens of thousands of patients are irradiated with photons, using complex radiation techniques. For the majority of people with cancer, this is an excellent therapy.
Treatment with protons is really an adjunct for cases where there are increased risks of side effects. In the future, we do expect an increase in the number of patients we are allowed and able to treat. The technology is developing rapidly and is also becoming more financially accessible.'
What does this center mean for the Northern Netherlands?
'Patients with cancer can receive the best possible care in their own region. With this addition, our oncological care is up to date. In addition, it will create at least fifty new jobs in the coming years. We are phasing in our maximum capacity of 600 patients per year and the workforce will grow along with it, from radiotherapists, lab technicians and clinical physicists to ICT staff and patient service employees. Interestingly, our proton facility also has an integrated physical, biological, clinical and economic research program aimed at improving clinical effectiveness.'
How does Groningen stand out from other centers?
'We are the first in the Netherlands, but compared with proton therapy centers in Europe and America, we have the latest equipment and an optimal workflow. Time is precious and we want to use this expensive equipment as efficiently as possible. We saw at other centers that this could be done better, so we developed a smart routing and tested it extensively during simulations.
Now it comes down to practice, while of course remaining keen on cost effectiveness. Because precisely in order to focus on patients and their treatment, healthy operations are
necessary.'
The Proton Therapy Center is a hospital-based facility on the grounds of UMCG and is an integral part of the Comprehensive Cancer Center. A few facts & figures:
- Annually 600 patients averaging 25 visits.
- A particle accelerator that weighs 220 tons.
- Concrete walls up to 4 meters thick to absorb residual radiation.
The total investment of 62 million euros was made possible in part by Investeringsfonds Groningen. Fund manager Jan Martin Timmer explains succinctly why: 'This center is of great social value and reflects the ambition of the Northern Netherlands.'
