Radiation Therapy in Gabon: Multi-Institutional Collaboration as a Paradigm for Growth in the African Radiation Oncology Sector

Balogun, Onyinye; James, L.; Chepkemoi, Luiza; Brereton, Harmar D.; Formenti, Silvia C.; Belembaogo, E.

doi:10.1016/j.ijrobp.2019.08.056

Cited by 1 publication

(4 citation statements)

References 9 publications

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“… 23 , 24 In Gabon, patient costs decreased from 51% to 22% of health spending from 2008 to 2020 because of increased government healthcare allocations, improving access for low-income patients. 25 Similarly, in Botswana, government subsidies comprise a significant portion of low-income patient coverage. 26 National insurance covers just 5% of Nigerians; because of financial constraints, only 22 of 66 patients for whom breast RT was recommended were referred, and only five completed treatment.…”

Section: Resultsmentioning

confidence: 99%

“…A Gabonese clinic recently converted to 3DCRT with help from Moroccan staff who spent 18 months facilitating the transition, leading to an appropriately staffed clinic. 25 Ethiopia has started a dual radiation/medical oncology training program for 7-10 trainees each year. 23 Partly because of government-sponsored education requiring trainees to practice locally, this has tripled the number of oncologists in the country between 2017 and 2020.…”

Section: Resultsmentioning

confidence: 99%

“…SSA has just 0.115 radiation machines per one million people, far less than the recommended 4, and many oncology facilities are without RT. 25 , 33 , 45 , 54 , 62 , 71 , 72 Even in areas with a growing RT capacity such as Botswana, the growth in cancer incidences outpaces that of RT services. 60 In other areas, issues surround the lack of brachytherapy, affecting CC outcomes despite adequate access to EBRT.…”

Section: Resultsmentioning

confidence: 99%

“…Partnerships between governments and outside organizations, such as in Gabon, may help expedite increased RT access by securing funding and providing training for local providers to deliver services, promoting sustainability. 25 Programs to increase the number of trained oncologists and retention strategies are needed, like in Ethiopia; however, careful consideration of dual radiation/medical oncology program development is essential. 23 Additional support staff in existing centers can improve efficiency, allowing for increased patient volume by permitting providers to focus exclusively on treatment planning–related care.…”

Section: Discussionmentioning

confidence: 99%

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Access to Radiation Therapy and Related Clinical Outcomes in Patients With Cervical and Breast Cancer Across Sub-Saharan Africa: A Systematic Review

Ponce

Abunike

Bikomeye

et al. 2023

JCO Global Oncology

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PURPOSE To better understand the barriers to accessing standard-of-care radiation therapy (RT) for breast and cervical cancer in sub-Saharan Africa and their impact on outcomes. METHODS A comprehensive literature search was completed with a medical librarian. Articles were screened by title, abstract, and full text. Included publications were analyzed for data describing barriers to RT access, available technology, and disease-related outcomes, and further grouped into subcategories and graded according to predefined criteria. RESULTS A total of 96 articles were included: 37 discussed breast cancer, 51 discussed cervical cancer, and eight discussed both. Financial access was affected by health care system payment models and combined burdens of treatment-related costs and lost wages. Staffing and technology shortages limit the ability to expand service locations and/or increase capacity within existing centers. Patient factors including use of traditional healers, fear of stigma, and low health literacy decrease the likelihood of early presentation and completion of therapies. Survival outcomes are worse than most high- and middle-income countries and are affected by many factors. Side effects are similar to other regions, but these findings are limited by poor documentation capabilities. Access to palliative RT is more expeditious than definitive management. RT was noted to lead to feelings of burden, lower self-esteem, and worsened quality of life. CONCLUSION Sub-Saharan Africa represents a diverse region with barriers to RT that differ on the basis of funding, available technology and staff, and community populations. Although long-term solutions must focus on building capacity by increasing the number of treatment machines and providers, short-term improvements should be implemented, such as interim housing for traveling patients, increased community education to reduce late-stage diagnoses, and use of virtual visits to avoid travel.

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