The Interterritorial Council of the National Health System (CISNS) has given the green light this Friday to the access criteria for proton therapy in the National Health System (SNS), through an agreement that defines homogeneous clinical requirements for the entire territory.
The reached pact includes a shared clinical prioritization system, a referral map between centers, and a protocol to coordinate care. The aim is to ensure equitable access to this service, regardless of whether the patient's autonomous community has its own equipment or not.
This concretizes the commitments made by this same body in December 2024 for a coordinated implementation of proton therapy. The procedures have been designed by expert professionals from different autonomous communities, under the coordination of the Ministry of Health.
The document establishes that prioritization will be carried out through a tool that will assign each patient a maximum score of 100 points, based on nine clinical parameters. Among them are age, tumor location, treatment indication, presence of metastasis, the need to re-irradiate the same area, and situations that require preferential attention.
In addition, specific circumstances related to radiosensitivity, fertility preservation, and the reduction of radiation dose to the fetus will be assessed. Thus, patients with higher scores will obtain a higher priority. This tool will serve to organize care but will not limit access to proton therapy, as all patients whose clinical indication is accepted will be able to receive the service.
Three phases of deployment of the equipment
Regarding the assignment of centers, the agreement details that it will adjust to the progressive implementation of the equipment. The first phase includes two units, in Santiago de Compostela (La Coruña) and Fuenlabrada (Madrid), during the first quarter of 2027. The second phase foresees four operational teams in the same period of 2028, with the incorporation of the units of Donostia (Guipúzcoa) and the La Fe University and Polytechnic Hospital of Valencia.
"During these initial phases, the territorial distribution will seek to balance the care burdens to avoid the saturation of the units," indicated Health, which added that "the planning takes as a reference the population under 27 years old, considered a priority in case of saturation, which does not imply excluding patients of other ages from treatment." "In this period, it may be necessary to maintain referrals to private centers with proton therapy units," it clarified.
In the third phase, it is expected that the 11 teams will be operational between the fourth quarter of 2028 and the first of 2029. From that moment on, the distribution will be based on the general population and geographical accessibility will be prioritized. The model will allow for modification of the assigned center for duly justified clinical or logistical reasons and will be subject to periodic review based on actual demand data.
The agreement also establishes that the Unique Proton Therapy Registry will act as a central tool to coordinate the entire care process, from the access request to the follow-up after treatment. All patients treated in the SNS proton therapy centers must be included in this registry.
The procedure will begin in the originating Radiation Oncology Service, which will incorporate the necessary clinical information for the destination center to evaluate the request. Once accepted, the proton therapy unit will organize the sessions according to the assigned priority.
After the completion of treatment, follow-up will be carried out from the originating Service, which will add data on the patient's evolution to the registry. This information will be complemented with outcome questionnaires communicated by the patients themselves, with the aim of measuring the effectiveness of treatments and reinforcing the evidence on the use of proton therapy in the SNS.