Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology · 2026
Inequitable access to proton beam therapy in Europe: Efficiency, equity, and strategic infrastructure planning to 2030.
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Wawrzuta Dominik, Klejdysz Justyna, Pędziwiatr Katarzyna, Chojnacka Marzanna
Аннотация
BACKGROUND AND PURPOSE: Proton beam therapy (PBT) may reduce treatment-related toxicity, but access remains highly unequal across Europe and may worsen as cancer incidence rises. We aimed to quantify current accessibility, project supply-demand dynamics to 2030, and identify where additional capacity could most reduce spatial inequality.
MATERIALS AND METHODS: We analysed PBT accessibility across 31 countries (EU-27, UK, and EFTA; 69,918 subregions) using the enhanced two-step floating catchment area (E2SFCA) method. Projections to 2030 included a baseline scenario incorporating planned facilities and rising cancer incidence, and an equity-optimised scenario assessing one additional single-room PBT unit within each eligible country, with countries ranked by the absolute reduction in the national weighted Gini index.
RESULTS: Estimated demand for PBT in 2025 totalled 78,500 patients. Despite existing infrastructure, over 56,000 patients lived in areas with no access or critical shortages (E2SFCA < 0.25). Projections to 2030 reveal divergent regional trajectories: Southern and Eastern Europe are projected to improve spatial equity through planned expansions, whereas Northern and Western Europe face declining capacity-to-demand ratios. Among the ten countries with the largest absolute modelled reductions in inequality, adding one strategically located single-room PBT facility was projected to reduce the national weighted Gini index by a mean of 35.4 %.
CONCLUSIONS: Substantial capacity deficits and spatial inequities persist across the European PBT landscape and are projected to intensify by 2030 without targeted policy intervention. While centralised, high-throughput centres remain efficient in smaller, densely populated countries, they are insufficient to ensure equitable access in geographically extensive nations, where decentralised networks incorporating single-room facilities may be more effective.
MATERIALS AND METHODS: We analysed PBT accessibility across 31 countries (EU-27, UK, and EFTA; 69,918 subregions) using the enhanced two-step floating catchment area (E2SFCA) method. Projections to 2030 included a baseline scenario incorporating planned facilities and rising cancer incidence, and an equity-optimised scenario assessing one additional single-room PBT unit within each eligible country, with countries ranked by the absolute reduction in the national weighted Gini index.
RESULTS: Estimated demand for PBT in 2025 totalled 78,500 patients. Despite existing infrastructure, over 56,000 patients lived in areas with no access or critical shortages (E2SFCA < 0.25). Projections to 2030 reveal divergent regional trajectories: Southern and Eastern Europe are projected to improve spatial equity through planned expansions, whereas Northern and Western Europe face declining capacity-to-demand ratios. Among the ten countries with the largest absolute modelled reductions in inequality, adding one strategically located single-room PBT facility was projected to reduce the national weighted Gini index by a mean of 35.4 %.
CONCLUSIONS: Substantial capacity deficits and spatial inequities persist across the European PBT landscape and are projected to intensify by 2030 without targeted policy intervention. While centralised, high-throughput centres remain efficient in smaller, densely populated countries, they are insufficient to ensure equitable access in geographically extensive nations, where decentralised networks incorporating single-room facilities may be more effective.