3720 - Inequity for the Territory: Disparity in Access to Proton Therapy for Australia's Most Unique Population

Purpose/Objective(s):

This project investigates whether cancer patients in the Northern Territory (NT) of Australia have equitable access to proton therapy. The NT’s population is young and diverse, with the highest proportion of Aboriginal and Torres Strait Islander Peoples (hereafter respectfully termed as Indigenous) at 30.8%. Despite known disparities in cancer outcomes for Indigenous Australians, there are no NT-specific pediatric oncology protocols. Patients eligible for proton therapy must navigate a complex application process requiring proton/photon comparative planning through the Australian Bragg Centre for Proton Therapy and Research (ABCPTR) to receive government-funded treatment overseas. We hypothesize that due to geographical, socioeconomic, and logistical barriers, NT patients (Indigenous patients in particular) are underrepresented in this pathway.

Materials/Methods:

NT Cancer Registry data was reviewed to quantify proton-relevant diagnoses using ICD-10 codes. These included Rhabdomyosarcoma, Ewing sarcoma, Neuroblastoma, Wilms tumor, Ependymoma, Medulloblastoma, Craniopharyngioma, Chordoma, and Pediatric Glioma. As this registry was only updated to 2022, the Australian Particle Therapy Clinical Quality Registry (ASPIRE – a registry of Australian patients with proton-relevant diagnoses) was screened for NT residents and compared to the ABCPTR registry to assess for comparative planning referral.

Results:

Between 2020 and 2022, eighteen proton-relevant cases were reported in the NT Cancer Registry, reflecting incidences consistent with population expectations. Extrapolating from this number, and considering ongoing population growth, a similar or greater number of diagnoses would be anticipated over the subsequent three years. However, since 2022, ASPIRE has identified only five patients from the NT who were potentially eligible for proton therapy, significantly below what would be expected based on the registry data. Of these five, two identified as Indigenous. One patient progressed to comparative planning but did not proceed with overseas proton therapy, while of the remaining four, two were unsuitable due to metastatic disease and two were not referred for unknown reasons.

Conclusion:

This preliminary analysis supports our hypothesis that NT patients are underrepresented in comparative planning referrals, and ultimately government-funded proton therapy overseas. Despite registry data indicating a significant incidence of proton-relevant cancers, actual referral numbers remain far below expectations. This shortfall likely reflects logistical barriers, limited access to local specialists, and systemic inequities affecting rural and Indigenous populations. Enhancing NT registry completeness, streamlining referral processes, and establishing dedicated pediatric oncology expertise within the NT could all help reduce this disparity, ensuring equitable access to advanced cancer care for all Australians.