Real-Time Rationing of Scarce Resources: The Northeast Proton Therapy Center Experience

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Abstract
The telephone line is silent. I have just delivered the news to an anxious mother whom I will never meet. We will not be able to offer her 3- year-old son, who recently underwent resection of a posterior fossa ependymoma, a treatment slot at the Northeast Proton Therapy Center in Boston, MA. Postoperative radiation is the standard of care for her son's disease, and radiating with protons might reduce the late effects of treatment to her young son's brain. Yet in light of the other patients competing for the scarce proton treatment slots, we must recommend that she pursue treatment for her son elsewhere, as we will not have an open slot in time. Because proton therapy is only available at our center and one in California, her son will most likely end up receiving conformal photon therapy, with a higher integral dose to the normal brain. "How can this be?" she asks. "Why can't my son get the treatment we feel would be best? We're in America.