What is proton beam therapy (PBT)?
Proton beam therapy is a type of radiotherapy.
Protons are small particles found in the middle of atoms. They can be used to give carefully calculated doses of radiation to treat diseases. This is different to standard radiotherapy which uses high energy X-rays (photons). Protons release their energy at an exact point in the body.
This means the dose to the tumour can be given very accurately and there is little or no dose to normal tissue past the tumour.
How is proton beam therapy delivered?
Proton beam therapy is given using a machine called a gantry. The gantry can rotate through 360 degrees. This means it is able to accurately aim the proton beam to the area needing treatment.
Proton technology in the UK offers pencil-beam scanning on each gantry. Pencil beam scanning uses a narrow beam of protons to move back and forth across the tumour site at a range of energies, to meet the required depth of the tumour.
How long will a course of proton beam therapy be?
A course of treatment can last 3-7 weeks. However, if you're referred for proton beam therapy, the duration of the treatment will be discussed with you at your initial appointment before you decide whether to go ahead with the treatment.
Proton beam therapy is given on an outpatient basis with treatment usually delivered Monday to Friday between the hours of 7am to 9pm. However, patients may occasionally need to attend for weekend treatments.
How long will my treatment take each day?
Appointments can take between 20-45 minutes each day.
Each appointment will include: changing times, taking X-ray pictures to check your position and the delivery of your proton beam therapy treatment. The radiographers will be with you until you are ready for the treatment to commence. The radiographers will explain the whole treatment process before treatment begins.
What are the side effects of receiving proton beam therapy?
You will have a consultation with your doctor to make sure you are fully informed about the possible early and late term side effects associated with your treatment, before being asked to sign a consent form. At any point before or during treatment, you will have the chance to ask any questions.
Radiographers, nurse clinicians and your doctor will routinely manage and advise on side effects throughout treatment.
Will I need a general anaesthetic to receive proton beam therapy?
No. This is generally for very young patients who cannot keep still.
When will proton beam therapy be available to NHS patients in the UK?
Proton beam therapy (PBT) has been available to UK patients since 2008 through the NHS-funded overseas programme, and The Clatterbridge Cancer Centre has treated patients with rare eye cancers with low-energy protons for many years.
The Christie is the first NHS high-energy PBT centre in the UK as part of a £250m programme for a national PBT service. A second PBT centre is also currently being built at University College London Hospitals NHS Foundation Trust. The new facility is due to open in 2020 with the PBT service ramping up in 2021.
How many people will the national proton beam therapy programme be able to treat?
Once both centres are running at full capacity, they will each be able to treat up to 750 patients every year – 1,500 in total nationally.
Who is eligible for proton beam therapy?
The treatment is particularly suitable for complex childhood cancers, with the potential to reduce side effects, such as deafness, loss of IQ and secondary cancers. It can also be used to treat cancers close to sensitive structures such as the brain, head, neck and spine.
It is important to remember that proton beam therapy is not suitable for everyone and conventional photon or X-ray therapy can be preferable. Advanced photon treatments are being developed all the time. In some cases, photon treatments are as good as or better than proton therapy.
The current commissioning policies for proton beam therapy can be found at the NHS England website.
Will all proton beam therapy (PBT) patients be treated at The Christie?
Developing a PBT service in this country for the first time is complex, and we will gradually be able to treat more and more patients here as both centres ramp up to capacity in the coming months and years. In the meantime, patients who are eligible for PBT will continue to be able to access treatment abroad in the current way until both The Christie and University College London Hospital are fully operational.
NHS England is working very closely with patient groups and expert clinicians to develop referral criteria that will define which patients receive their treatment overseas and which are referred into the NHS service during the transition period.
Can I self-refer for proton beam therapy at The Christie?
No, The Christie does not accept self-referrals. All patients must be referred by their local cancer centres, usually by a consultant clinical oncologist.
I am a UK resident living in one of the devolved administrations. Can I receive NHS funded proton beam therapy at The Christie?
The NHS in England is a residence-based system, unlike many other countries, which have insurance-based healthcare systems. This means that visitors to England may have to pay for NHS healthcare, depending on their circumstances.
The devolved administrations, Scotland, Wales and Northern Ireland can access proton beam therapy at The Christie if the respective administrations approve it.
Further information can be found at NHS Choices.
I think I am eligible for proton beam therapy – who should I contact?
You need to contact your clinical oncologist at your local cancer centre in the first instance to discuss your options and they will advise you on the next steps. The Christie is not able to advise potential patients directly.
I have heard that NHS prostate cancer patients will not routinely be treated with proton beam therapy, is that correct?
Yes, that is correct. NHS England has reviewed the clinical evidence available for the use of proton beam therapy to treat prostate cancer and produced a document that explains this decision, which can be accessed here.
Does The Christie decide what type of patients should be treated with protons?
No, these decisions are made by NHS England, based on the best available evidence on the effectiveness of proton beam therapy for specific types of cancer. If you have questions about whether you might benefit from proton beam therapy, you should speak to your local clinical oncologist in the first instance as The Christie can’t advise directly on individual cases.
Can I pay privately to receive proton beam therapy at The Christie?
The Christie provides an NHS funded service and has no plans to offer a private proton beam therapy service.
What is a key worker?
A key worker is a specialist radiographer or nurse who will contact the patient and/or carer once they have been accepted for proton beam therapy. The key worker will be the first point of contact for the patient and carer throughout the patient’s journey at the proton beam therapy centre.
They will also be a contact for the doctors and health professional team at the referring hospital nearer to the patient’s home. You will have frequent contact with your key worker throughout both the assessment visits and during the treatment itself.
Travelling to The Christie
The proton beam therapy centre is accessible via air, road and rail. For help in planning your journey, please visit The Christie website.
Further travel information can be found at Transport for Greater Manchester.
Do I have to pay for travel?
Payment for travel depends upon individual circumstances. This is detailed in the NHS Travel Policy, which will apply for proton beam therapy patients.
Car parking at the proton beam therapy centre
There is a drop area only for patients outside the proton centre.
Cost for parking is in line with the rest of the trust. Further parking information can be found here
Ambulance transport for patients
Hospital transport is provided by North West Ambulance Service and West Midlands Ambulance Service. This service is not applicable for patients outside the area. If you're unsure, please speak to your key worker or the scheduling team to clarify.
Contact the transport liaison office at The Christie directly on 0161 446 8114 or 8143 for advice and bookings (Monday to Friday, 8.00am – 6.00pm).
Ambulance transport can be arranged subject to eligibility criteria based on medical need. There also must be a medical need for you to bring an escort on hospital transport.
Depending on how far away you live, you may be eligible for accommodation. We will inform you of this once your initial appointment with us has been confirmed. The booking of accommodation will be made by the scheduling team, however you will be asked to contact the accommodation provider directly in order to confirm this booking.
Please note, transport from your home address to the accommodation will not be provided by The Christie, you must make the arrangements yourself. Please speak to your referring centre if you have any issues.
Where we are able to offer accommodation, transport between the accommodation and The Christie will be provided free of charge.
Further travel information can be found at Transport for Greater Manchester.
Who pays for the accommodation?
If accommodation has been allocated, NHS England will provide funding to cover the cost of accommodation during your stay for assessment and treatment. Patients staying in the accommodation are responsible for their own food, additional services and any extras they may wish to add. NHS England will only pay the basic rate for the apartment allocated to you.
Patients accommodated are also responsible for any damage that occurs to the accommodation.
Who can stay at the accommodation?
For patients 16 years old and under, accommodation will be allocated for themselves and two other carers. For patients over 16 years old, accommodation will be allocated for themselves and one other carer.
The costs of any additional accommodation needs beyond those described above must be funded by the patients themselves. Please contact the scheduling team if you have any questions regarding an accommodation offer that has been made to you.
Who will pay for the cost of travelling to the accommodation?
The Christie will not fund the cost of travelling from your home address to the accommodation. Please discuss with your referring local cancer centre for any questions or queries relating to this.