Closer to Care Series: The Access Gap in Particle Therapy

Particle therapy was supposed to change everything.

For decades, proton and carbon ion therapy have been held up as some of the most promising advances in radiation oncology. By exploiting the unique physics of the Bragg peak, particle beams can deliver radiation directly to a tumor while minimizing exposure to surrounding healthy tissue. The potential benefits are significant: reduced long-term toxicity, lower risk of secondary cancers, and improved treatment options for pediatric patients and those with complex tumours [1].

The science is compelling. The clinical evidence continues to grow.

And yet, despite decades of development and investment, fewer than 1% of radiotherapy patients worldwide receive particle therapy, even though some estimates suggest that up to 50% of patients could benefit in specific clinical indications [2].

This is not a story about a failure of science.

It is a story about a failure of access.

 

The Global Promise and the Global Reality

When particle therapy emerged, it represented a vision for the future of cancer care: more precise treatments, better outcomes, and fewer long-term side effects.

But for most patients, that future remains out of reach.

The challenge is not whether particle therapy works. The challenge is that the way it has been designed, deployed, and scaled has created barriers that prevent many patients from ever accessing it.

As a result, one of oncology’s most advanced treatment modalities remains available to only a small fraction of the people who could potentially benefit from it.

 

The Economics Were Never Built for Scale

One of the biggest barriers to access is the economic model on which particle therapy has historically been built.

Most systems were designed around large, centralized facilities requiring substantial capital investment. Building a particle therapy centre can cost anywhere from tens of millions to well over one hundred million dollars [1], while annual operating costs can reach several million more [3]. Treatment courses themselves often carry significantly higher costs than conventional radiotherapy reaching as much as $150,000 for one course of treatment [4].

These economics create challenges even within well-funded healthcare systems. Some facilities have struggled financially [5], and debates around cost-effectiveness continue, particularly for common cancer indications where reimbursement remains uncertain [6].

The result is a model that naturally limits adoption. Rather than becoming a broadly available treatment option, particle therapy has remained concentrated within a relatively small number of specialist centres.

The question is no longer whether particle therapy provides clinical value. The question is whether the current delivery model can realistically support widespread access.

 

Geography Still Determines Opportunity

Perhaps the most striking aspect of the access challenge is how heavily it depends on where a patient lives.

Despite growing interest in particle therapy, there are still fewer than 150 operational centres worldwide. The vast majority are concentrated in North America, Europe, and parts of Asia, leaving large regions of the world with little or no access [4].

For many patients, receiving treatment requires travelling long distances, crossing borders, taking extended time away from work and family, and absorbing significant out-of-pocket costs.

In theory, access should be determined by clinical need.

In practice, it is often determined by geography.

A patient living near a major treatment centre may have access to advanced particle therapy. A patient with the same diagnosis living elsewhere may never even be considered for treatment.

That disparity highlights a fundamental issue: availability does not automatically translate into accessibility.

 

Complexity Has Become a Bottleneck

Particle therapy’s technical sophistication is one of its greatest strengths. It is also one of its biggest barriers.

Traditional systems are physically large, highly specialized, and dependent on expert teams to install, operate, and maintain them. The global workforce capable of supporting these systems remains relatively small, creating additional constraints on growth and adoption.

Even in regions where facilities exist, complexity can limit utilization. High maintenance requirements, specialist staffing needs, and operational challenges all contribute to capacity constraints that make expansion slower and more difficult than many anticipated.

The result is a paradox. A technology designed to improve patient outcomes can only reach a limited number of patients because the systems themselves remain difficult to deploy at scale.

 

When Innovation Reinforces the Problem

The first generation of particle therapy systems achieved something remarkable. They established clinical credibility, generated evidence, and demonstrated the value of particle therapy in cancer treatment.

But they were also developed during a period when innovation was largely focused on increasing capability and throughput.

Systems became larger. Facilities became more complex. Infrastructure requirements expanded.

From a technical perspective, these developments made sense.

From an access perspective, they often reinforced existing barriers.

As the industry pursued larger facilities and more sophisticated installations, particle therapy became increasingly optimized for major academic centres and flagship institutions. Smaller hospitals and regional cancer centres were largely excluded from participation.

In many ways, the industry’s pursuit of scale unintentionally reduced scalability.

 

The Illusion of Progress

It would be easy to look at the growing number of particle therapy facilities under development and conclude that the access challenge is solving itself.

More than 60 new particle therapy centres are currently under development worldwide, according to the National Association for Proton Therapy, with projects spanning Asia, Europe, and North America [5].

That growth is encouraging, but growth alone does not guarantee access.

If new facilities continue to rely on expensive, centralized, and highly complex infrastructure, the industry risks reproducing the same limitations in more locations. The number of centres may increase while the underlying accessibility problem remains largely unchanged.

Expansion and democratization are not the same thing.

 

What Needs to Change

If particle therapy is to transition from a highly specialized treatment option to a widely available standard of care, the industry must rethink the model itself.

The next phase of innovation needs to focus not only on clinical performance, but also on accessibility, practicality, and scalability.

This means:

• Designing systems with smaller physical footprints that can fit within existing oncology departments.
• Reducing infrastructure requirements and eliminating unnecessary complexity.
• Making installation faster and more cost-effective.
• Enabling regional cancer centres, not just flagship institutions, to offer treatment.
• Building solutions that require fewer specialized resources to operate and maintain.

Most importantly, it means designing around the patient rather than around the machine.

For decades, patients have adapted to the limitations of treatment systems. The future may require treatment systems that adapt to the realities of patient care.

 

A Different Future Is Emerging

Across the industry, a new generation of thinking is beginning to challenge long-standing assumptions.

The belief that particle therapy must be large, expensive, and restricted to elite centres is increasingly being questioned. New approaches are exploring how infrastructure can be simplified, how patient positioning can be reimagined, and how systems can be integrated more effectively into existing hospital environments.

These developments are not simply incremental improvements.

They represent a fundamental shift in how particle therapy can be delivered.

By reducing infrastructure requirements, lowering total cost of ownership, and enabling deployment in smaller clinical settings, the industry has an opportunity to move beyond the limitations of the past and bring advanced cancer treatment closer to the patients who need it.

 

Conclusion

Particle therapy does not have a science problem.

It has an access problem.

For years, the industry has focused on advancing treatment capabilities, improving clinical outcomes, and expanding technical performance. Those efforts have been essential and have helped establish particle therapy as one of the most promising tools in modern oncology.

The challenge now is different.

The challenge is ensuring that more patients can actually benefit from those advances.

Until accessibility becomes a core design principle, millions of patients will remain excluded from treatment options that could improve their outcomes and quality of life.

The next era of particle therapy will not be defined solely by beam energy, treatment speed, or technical specifications.

It will be defined by the industry’s ability to make advanced cancer care more accessible, practical, and scalable.

Because breakthrough technology only changes lives when patients can reach it.

Learn more about Marie®, Leo Cancer Care’s approach to making particle therapy more accessible, scalable, and practical for modern oncology environments.

 

References

1. Spitto MT, et al. Proton Radiotherapy to Reduce Late Complications in Childhood Head and Neck Cancers. International Journal of Particle Therapy. 2021, 8(1):155-167. ISSN 2331-5180. https://doi.org/10.14338/IJPT-20-00069.1.
2. Susu Yan, et al. Global democratisation of proton radiotherapy. The Lancet Oncology. 23(6): e245-e254. ISSN 1470-2045. https://doi.org/10.1016/S1470-2045(23)00184-5.
3. Global particle therapy market report size, share, growth drivers, trends, opportunities and forecast 2025-2030. Available at: Global Particle Therapy Market | 2019 – 2030 | Ken Research
4. Yadav, S. Particle Therapy System Market Analysis 2026. Available at: Particle Therapy System Market Analysis 2026, Market Size, Share, Growth, CAGR, Forecast, Trends, Revenue, Industry Experts, Consultation, Online/Offline Surveys, Market Analysis and Proprietary database
5. NAPT News. Pursuing Lower Costs and Greater Access to Proton Therapy. 2022. Available at: Pursuing Lower Costs and Greater Access to Proton Therapy – National Association for Proton Therapy
6. Busschaert S, Kimpe E, Gevaert T, De Ridder M, Putman K. Cost-Effectiveness of Proton Therapy Compared With Photon Therapy in Breast Cancer. JAMA Netw Open.2026;9(1):e2554888. doi:10.1001/jamanetworkopen.2025.54888