Grand Challenge Network+ in Proton Therapy

The aim is to estimate the impact of COVID-19 on proton therapy and radiotherapy (RT) services more generally at national and regional level across the UK. We will use our mathematical model of radiotherapy demand (MALTHUS) which was commissioned for the NHS by Prof Sir Mike Richards when he was Cancer Czar. Through adapting MALTHUS we will be able to understand the impact of COVID-19 on radiotherapy practice across the UK and to use it as a scenario modelling tool to provide a long-term assessment of how the provision of radiotherapy will change for different cancer anatomical sites as a result of COVID-19. MALTHUS uses factors relating to patient case-mix, indications for radiotherapy treatment and evidence-based radiotherapy fractionation which are encoded into decision trees representing cancers treated by radiotherapy. Base data for local-level population and cancer registrations were obtained from the National Cancer Intelligence Network and Office of National Statistics. Malthus uses a sophisticated discrete-event simulation algorithm that can provide statistically robust estimates of treatment demand. MALTHUS will be adapted to include new RT evidence and protocols, which reflect the current COVID-19 changes occurring within the NHS. This will allow for scenario-based service simulations that evaluates the practice changes, current reduction in cancer patients and potential backlogs of patients requiring RT and what it will mean for services and patients. Economic factors will be included through integrating NHS tariff charges. Initial service data will be obtained through the Christie NHS Foundation Trust's Big Data Radiotherapy project. MALTHUS is an active framework model used nationally and internationally. MALTHUS is already collaborating with Greater Manchester Cancer (part of the devolved health system) and the CRUK Radiotherapy Policy team. We will work closely with the Christie to develop the service scenarios and collaborate with their radiotherapy and lung cancer research projects, who are gathering COVID-19 RT activity and patient outcome data. This will enable the investigation of wider health economic impacts of changes made to current practice through using QALYs and cost-effectiveness analysis. The project will collaborate with two additional cancer centres to trial scenario simulations. If successful, we will work with national bodies (such as CTRad and RCR) to make the simulations available to all NHS radiotherapy services.