Outside of Japan, proton beam therapy is in such high demand it’s as-of-yet-unopened Ontario. Consequently, it has grown to be the costliest procedure reimbursed through the Out-of-Country Prior Approval Program, placing tremendous financial strain on the province. Patients have been traveling to the United States for this specialized treatment since 2018. They are looking for care that is not available at all in any part of Canada. This gap in local services has resulted in Ontario spending millions on medical bills for patients seeking proton beam therapy abroad.
One appealing trend, according to Dr. David Urbach, the chief of the surgery department at Women’s College Hospital in Toronto. Once again, he faces a case involving proton beam therapy every other week. The therapy delivers targeted radiation to tumors while minimizing damage to surrounding healthy tissue, making it an appealing option for patients with specific cancers. Ontario’s healthcare system has so far been unable to build the capacity to bring this newer, more advanced treatment closer to home.
In 2024, Ontario’s proton beam therapy costs reached $2.4 million for 29 approved requisitions. This spending clearly made it the largest spending of any project in the Out-of-Country Prior Approval Program. In fact, the costs of this program represent less than one percent of the province’s total healthcare expenditures. They raise concerns over the need for accessibility and further promote the growing need for local solutions.
Growing Demand for Proton Beam Therapy
As the number of patients wanting proton beam therapy has risen, it has become clear that demand exceeds existing referral rates. Dr. John Bauman, a radiation oncologist at Victoria Hospital in London, Ont., notices this as a concerning trend. He suspects that Ontario is “under-referring” patients for this important treatment. Vanderlaan is hopeful that with proton beam therapy finally available in the province that most patients would be able to have the treatment.
In short, protons have real advantages in 10 to maybe 20 percent of all radiation therapies. In short, if we have this option available to us, it’s worth exploring them. We’re down to a few thousand [patients] a year, Dr. Bauman stated. This statistic highlights the potential number of patients who could receive better care if access to proton beam therapy were improved within Ontario.
Hundreds of other patients have commuted to centers such as the UF Health Proton Therapy Institute in Florida. First, Luke Serfas received treatment there after his story prompted the Alberta government to pay for his care. He had to spend six to eight weeks in Jacksonville for his therapy. This underscores the logistical and financial burdens patients like Henry must bear when forced to seek care far from their home province.
“There’s probably more people who, if that service were available, would do it here, but because it’s a big upheaval, it’s expensive to travel outside the country, they might not be taking advantage of that.” – Aaron Jones
The Cost of Seeking Care Abroad
Meanwhile the financial treatment of getting proton beam therapy overseas is significant. Patients are left with medical bills and other travel costs that add up to over half a million dollars on average per completed and approved request. These high costs have sparked important conversations in terms of equity and accessibility to life-saving treatments for all Ontarians.
Beyond its exorbitant price tag, proton beam therapy offers distinct advantages. It’s a clean approach, not only striking the tumor, but preserving healthy tissue around it. This targeted approach has made it a popular first-line choice for several conditions. Dr. Urbach noted that “the problem in particular with phalloplasty is that the numbers of procedures tend to be much smaller,” indicating that some specialized treatments may not be feasible to offer locally due to low demand.
This level of advanced care is complex to provide, and Ontario’s Ministry of Health has recognized this. In particular, they pointed out underutilization of some services. Second, they noted the discrepancies in how some of these services are coded and categorized in the healthcare system.
“There may be variations in how the same service is written.” – Ministry of Health
This recognition opens the door to crucial discussions. We have to find smarter, more efficient ways to deliver service to patients who require proton beam therapy and other specialized treatments.
Future Considerations for Ontario’s Healthcare System
These challenges and increasing costs have ignited critical conversations about how a proton beam therapy facility can be set up in Ontario. Buzz about this project is growing in leaps and bounds. Experts propose that a facility with up to five treatment suites could support nearly 1,500 pediatric and adult patients annually. Such an investment would not only relieve the travel burden but make it easier for patients in underserved communities to access advanced cancer treatment close to home.
Prof. Arthur Sweetman, co-director of the Centre for Health Economics and Policy Analysis at McMaster University. He returned to the point that our healthcare services need to focus on what makes each individual patient unique. Among his observations, he started with the simple fact that with more demand, Ontario needs to make more supply.
“Someone is paying attention, there’s a natural evolution. As demand increases, as need increases, Ontario responds.” – Prof. Sweetman
Establishing such facilities comes with challenges. Dr. Bauman highlighted the expertise required to operate these advanced machines, stating, “These are expensive machines. They need a lot of people to keep them up, physicists, engineers. They’re just very expensive equipment to maintain.” This further emphasizes the importance of advancing planning and investment in human resources to keep pace with technology.
