Access to Radiation Therapy: From Local to Global and Equality to Equity

Abstract

The discipline of radiation oncology is the most resource-intensive component of comprehensive cancer care because of significant initial investments required for machines, the requirement of dedicated construction, a multifaceted workforce, and recurring maintenance costs. This review focuses on the challenges associated with accessible and affordable radiation therapy (RT) across the globe and the possible solutions to improve the current scenario. Most common cancers globally, including breast, prostate, head and neck, and cervical cancers, have a RT utilization rate of > 50%. The estimated annual incidence of cancer is 19,292,789 for 2020, with > 70% occurring in low-income countries and low-middle–income countries. There are approximately 14,000 teletherapy machines globally. However, the distribution of these machines is distinctly nonuniform, with low-income countries and low-middle–income countries having access to < 10% of the global teletherapy machines. The Directory of Radiotherapy Centres enlists 3,318 brachytherapy facilities. Most countries with a high incidence of cervical cancer have a deficit in brachytherapy facilities, although formal estimates for the same are not available. The deficit in simulators, radiation oncologists, and medical physicists is even more challenging to quantify; however, the inequitable distribution is indisputable. Measures to ensure equitable access to RT include identifying problems specific to region/country, adopting indigenous technology, encouraging public-private partnership, relaxing custom duties on RT equipment, global/cross-country collaboration, and quality human resources training. Innovative research focusing on the most prevalent cancers aiming to make RT utilization more cost-effective while maintaining efficacy will further bridge the gap.

An investigation of digital skills of therapeutic radiographers/radiation therapists: A european survey of proficiency level and future educational needs

“…To compensate, a strong emphasis was placed on disseminating the survey across European professional organisations. Although there is no formal estimate available globally for the number of TR/RTTs, 51 based on the most recent HCPC data, 52 the number of TR/RTTs females/males in this study (72.3% and 26.7%, respectively) was similar to the TR/RTT population in the UK, and can be expected that the proportion is similar across Europe. The survey was sent via email by the professional organisations (ART, PTE, SRM and EFRS) to professionals who agreed to receive this type of information and picked up by social media.…”

Hypofractionation Adoption in Prostate Cancer Radiotherapy: Results of an International Survey

“…Furthermore, the gap in access to treatment equipment is striking, with LLMICs having access to <10% of global teletherapy machines, despite >70% of the annual incidence of cancer occurring in these countries. 14 Hypofractionation therefore offers an important advantage as it allows for more efficient use of available resources. Another explanation for this discrepancy could be that patients from UMICs and LLMICs are under-represented in clinical trials.…”

Updates in global oncology: Advancements and future directions

“…Radiation oncology is considered the most resourceintensive component of comprehensive cancer care because of the significant initial investments required for machines, a multifaceted workforce, and recurring maintenance costs. 90 Given the need for these resources, in addition to the financial barrier for patients seeking radiation, there are significant disparities in access to treatment. 91,92 Despite its relative scarcity, models show that expanding access to radiotherapy could lead to survival gains of 2.5% to 6.1% in LMICs.…”