Proton Radiation: Why Canadian children deserve better?
Children with cancer deserve access not just to treatment but to the best the world has to offer. Yet, across Canada, young and the most vulnerable children are deprived of one of the most advanced, evidence-backed radiation options available today: proton beam therapy (PBT).
As of May 2022, there were 114 clinical PBT facilities in 20 countries. These include major centres across Europe, Asia, and the United States. Even rapidly developing economies like India and China operate at least one facility each. Canada, however, stands alone: the only G7 country without a single PBT facility either operational or under construction. Meanwhile, just across the border, the United States has 45 centres, making the therapy widely accessible to American children.
This gap is not just about technology; it is about equity, dignity, and responsibility in pediatric cancer care.
What is Proton Radiation?
PBT is an advanced form of radiation therapy used to treat various cancers. Cancer treatment often involves multiple modalities, including surgery, chemotherapy, and radiation therapy. Among these, radiation plays a critical role and is used in up to 50 per cent of all cancer cases.
Today in Canada, all radiation is photon–based, the conventional form. While effective, photon therapy releases energy along its entire path, damaging healthy cells and surrounding tissues.
Proton radiation is different. It uses positively charged particles called protons, which release most of their energy precisely at the tumor site and then stop. This is known as the Bragg peak, and it drastically limits radiation exposure to nearby healthy tissues.
This precision makes PBT especially valuable for
- Pediatric tumors, where protecting developing organs is crucial
- Adolescent and young adult (AYA) cancers, where long-term side effects can impact decades of life
- Tumors near critical organs such as the brain, spine, optic nerves, and heart
Why do children need proton radiation?
Children are not mini adults. Their brains, hearts, bones, and endocrine systems are still developing, making them far more vulnerable to radiation damage.
Conventional radiation
- Can impair cognitive development
- Increases the risks of learning difficulties, memory problems, and attention deficits
- Can cause hormonal disorders, growth abnormalities, and organ damage
- Significantly increases the risk of secondary cancers later in life
As a result, many survivors may struggle with lifelong disabilities affecting education, employability, independence, and ultimately quality of life.
Proton therapy minimizes these risks. By sparing healthy tissue and reducing unnecessary radiation exposure, PBT often translates to better long-term neurological outcomes, lower toxicity, fewer hospitalizations, and a greater chance for children to live full, independent lives.
What Happens Today if a Child Needs Proton Therapy?
In Canada, children who need PBT must be sent out of the country, almost always to the US, through a case-by-case referral system. While provincial ministries typically cover direct treatment costs, many families must shoulder thousands of dollars in flights, accommodation, food, and loss of income during long stays away from home.
Most families depend on fundraisers, charities, or community donations to make the treatment trip feasible. And eligibility varies by province, creating deep inequities based on postal code. Some children get approval quickly, while others face painful delays.
Families also face non-financial burdens like the stress of urgently relocating to another country, the risk of traveling soon after surgery or during fragile recovery periods, or administrative delays that can eat into critical treatment timelines.
Let’s look at the economics?
Beyond the moral and clinical arguments, the financial case of not having a PBT facility in Canada is striking. According to the Ontario Health Technology Assessment Report 2021, the per-patient cost of referring to a US hospital stands at $327,000. In comparison, building and operating a PBT centre can bring down the average cost per patient to about $48,000. That is a seven-fold difference!
Building and operating a PBT facility is a long-term investment that not only reduces provincial expenditure and keeps families close to home but also supports research and innovation in pediatric oncology.
Canada already pays millions annually to US centres. For a fraction of that cost, it could build a world-class facility here, thereby strengthening our health system for generations.
Conclusion
Proton therapy is not experimental; it is a well-established standard of care for many pediatric and young adult cancers. When access is delayed, children suffer consequences. My son relapsed while we waited for approvals for proton radiation in the US, and I know firsthand how devastating those delays can be. No family should have to navigate uncertainty and bureaucracy in the middle of their child’s cancer fight. We can, and must, do better for future families.
Neha Bhatnagar