Background The goal of the Proton Priority System (PROPS) is to

Background The goal of the Proton Priority System (PROPS) is to guide the allocation of proton therapy treatment at region would outstrip our capacity to provide treatment especially during the Center’s ramp up phase. us to balance evidence of effectiveness equity and the ability to generate new knowledge to advance the field. In this report we present the AMG-Tie2-1 underlying principles and rationale for PROPS and examine its application in AMG-Tie2-1 treatment allocation among patients with a range of cancer diagnoses. METHODS Setting The Proton Therapy Center at opened in January 2010 The Center has four gantries and one fixed beam room. Pencil beam scanning is available on two gantries and the fixed beam. As with other proton centers the facility continues to expand treatment availability through a staged approach. During the study period our Center’s capacity to provide treatment remained greater than patient demand. In December 2012 approximately 85 treatment slots were available Rabbit Polyclonal to SLC4A8/10. daily. Proton Priority Oversight and Advisory Board (POAB) In September 2009 we established the POAB to develop and oversee a multi-stakeholder process for proton treatment slot prioritization. The POAB comprises AMG-Tie2-1 members from the clinical and University community including two representatives from Radiation Oncology a medical oncologist a surgical oncologist a medical ethicist a nurse and a patient representative. The POAB established principles of proton therapy prioritization and developed the Proton Priority System (PROPS) to guide the allocation of patient treatment slots. Principles of Proton Therapy Prioritization As noted we anticipated the need to prioritize proton therapy based on comparative clinical need a sense of justice over scarce resources and a desire to advance our knowledge of the best uses of proton therapy. Accordingly PROPS is based on five primary considerations that draw from prior work examining resource allocation in health care: incremental benefit age (‘youngest first’) equity contribution to medical knowledge and transparency.5-8 First the primary concern of PROPS is the incremental benefit of proton therapy for patients. Incremental benefit from proton therapy in this context can be defined as the extent to which an individual patient would benefit from proton treatment as compared to alternative treatments. Defining incremental benefit for proton therapy is challenging because experience with the treatment is limited beyond select cancers and essentially no comparative trials have been performed. AMG-Tie2-1 Therefore the PROPS score reflects the expert opinions of the community of clinicians and other stakeholders at values and contributes to the advancement of medical knowledge. PROPS considers the extent to which patients are eligible and willing to participate in active clinical research protocols as the benefit from treating such patients extends beyond the individual. While we did not want to make participation in research a condition of receiving proton therapy we wanted to encourage research participation in order to grow the evidence base for future patients. Fifth the prioritization process should be transparent to patients and clinicians.10 To that end the POAB is a peer-review board and encourages dissemination of the rationale for and processes of PROPS. This paper is part of that process. The Proton Priority System (PROPS) Score The purpose of the PROPS score is to guide the allocation of proton therapy through AMG-Tie2-1 an objective priority points framework that assigns higher scores to patients who are more likely to benefit from proton therapy. The PROPS score consists of a weighted sum of seven domains: diagnosis anatomic site stage performance status/comorbidities age urgency and protocol participation. Within each domain is a set of factors used to evaluate patients. Factors within domains are given a priority score of 0 – 10 with more points given for factors in which proton therapy is thought to offer greater AMG-Tie2-1 benefit (Table 1). Each domain is given a weight with more weight given for domains in which proton therapy is thought to offer greater benefit as well (Table 2). The weighted sum allows for the incorporation of between-domain weights. A higher weighted PROPS score may indicate a particularly compelling case for proton therapy. Strict domain definitions were established to promote the greatest possible objectivity (Table 3). Table 1 Within-Domain.