Implementation of a new hadrontherapy pediatric pathway: results from CNAO (National Centre for Oncological Hadrontherapy), Italy
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Università degli Studi di Pavia Department of Public Health, Experimental and Forensic Medicine Italy
CNAO Foundation Italy
Publication date: 2023-04-26
Popul. Med. 2023;5(Supplement):A1126
Background and Objectives:
The National Centre for Oncological Hadrontherapy (CNAO) in Pavia, an innovative and technologically state-of-the-art facility, is one of the 6 centres in the world treating patients with solid inoperable radioresistant tumours using protons and carbon ions (hadrons) since 2011. Following hadrontherapy inclusion within the National Health Service in 2017, patients treated progressively increased. Recently, CNAO adopted a new care pathway for pediatric patients from Italy and other countries.

We analysed administrative anonymised data of patients treated between 2017 and November 2022, considering patients’ age group and treatment duration. We collected qualitative data on the implementation of the pediatric pathway, whose team includes radiation oncologists, radiologists, anaesthetists, nurses, radiographers, biomedical engineers and psychologists. Specific patient-centred interventions have been developed to improve care humanisation and compliance by patients and their families.

Out of 2,621 patients treated between 2017 and 2021, 54 (2.1%) were children, while in 2022, this share has risen to 7.8% (35 children out of 451 patients). Mean age was 12 years (range 2-17), and mean treatment course duration was 42 days (range 21-57), which was significantly higher than for adults because of disease and patient characteristics (tumour types and need for sedation). In 2022 there were no treatment interruptions among children, whose compliance was improved with a range of initiatives (dedicated pediatric recovery room, customised radiotherapy masks and children-targeted communication program, including books, cartoons and gadgets).

CNAO has progressively improved competencies in treating pediatric patients in terms of scientific knowledge, staff expertise and organisation, thus increasing treatments number per year and emerging as a point of reference in the pediatric network. The implementation of a targeted care pathway with a dedicated multidisciplinary team allowed for the improvement of care quality and patients’ compliance in a referral centre at the national and international levels.