Remote Global Radiation Oncology Education and Training: A Pathway to Increase Access to High-Quality Radiation Therapy Services in Low- and Middle-Income Countries

Kavuma, Awusi; Kibudde, Solomon; Schmidt, Matthew; Zhao, Tianyu; Gay, Hiram A.; Li, Benjamin; Michalski, Jeff M.; Hugo, Geoffrey D.; Vanchinbazar, Enkhtsetseg; Minjgee, Minjmaa; Nansalmaa, Erdenekhuu; Ssewamala, Fred M.; Velarde, Angel; Falla, Dra. Vicky De; Ixquiac, Milton; Henke, Lauren E.; Rheenen, Jacaranda van; Sun, Baozhou

doi:10.1016/j.adro.2023.101180

Cited by 5 publications

(4 citation statements)

References 20 publications

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“…The pre-training survey also revealed baseline gaps in the training and confidence levels of radiation oncologists with regards to pediatric radiation oncology. Our findings are similar to that of Kavuma et al who also reported low confidence levels in using IMRT among radiation therapy professionals in low-and-middle income countries, including Africa [ 20 ]. The majority of surveyed radiation oncologists had not received any previous pediatric radiotherapy-specific training despite working in centers that provide care to pediatric cancer patients.…”

Section: Discussionsupporting

confidence: 91%

“…This indicates that the program had a significant positive impact on participants' skill and confidence in this critical aspect of pediatric radiotherapy. Kavuma et al (2023) reported similar results after providing training to 37 healthcare professionals from Uganda, Guatemala, and Mongolia; finding that the remote training significantly improved the average experience and confidence level in contouring, site-specific target/organ definition, planning/optimization, and quality assurance amongst radiation oncologists, medical physicists, radiation therapy technologists and dosimetrists [20]. Accurate delineation of target volumes is absolutely essential for precise radiation treatment, and the observed improvement in confidence levels could be extrapolated to assume improved capacity in this skill [22].…”

Section: Discussionmentioning

confidence: 99%

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Increasing pediatric radiation oncology capacity in sub-saharan Africa using technology: a pilot of a pediatric radiation oncology virtual training course

Joseph,

Akinsete,

Ajose

et al. 2024

BMC Med Educ

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Background The shortage of skilled healthcare professionals in pediatric oncology and the limited access to training programs remain significant challenges in Nigeria and sub-Saharan Africa. The the Pediatric Radiation Oncology (Virtual) Course, ‘PedROC’ project aims to contribute to improving pediatric cancer outcomes in Nigeria by increasing the capacity of radiation oncology professionals. To address the gap in access to pediatric radiation oncology professional development, the PedROC project was created, harnessing technology to improve radiation oncology training via a curriculum delivered through web-conferencing. This study aimed to evaluate the effectiveness of the PedROC pilot in enhancing the capacity, confidence, and skill of radiation oncologists in decision-making, prescribing, and treatment planning of radiotherapy for children diagnosed with cancer. Methods A multidisciplinary faculty of specialists in radiation oncology, pediatric oncology, oncology nursing, radiation therapy technology, and medical physics collaborated to identify the key learning needs in pediatric radiation oncology in the country. The team collaborated to develop a comprehensive curriculum covering the most common pediatric cancers in sub-Saharan Africa for the training program. The training course was conducted over two days, delivering twenty-four half-hour sessions for a total of 12 h, from July 31 to August 01, 2021. Results Analysis of pre and post - training surveys showed a significant increase in self-reported confidence measures across all domains among radiation oncologists. The program successfully improved participants’ knowledge and confidence levels in managing common pediatric cancers using radiotherapy, particularly addressing radiotherapy-specific issues such as appropriate dose, target volume delineation, treatment planning, dose constraints, and plan evaluation. Conclusion The PedROC pilot showed the efficacy of this model in enhancing the capacity and confidence of radiation oncology professionals involved in the treatment of pediatric cancer. The findings indicate that technology holds significant potential to increase pediatric radiation oncology capacity in Africa, ensuring improved access to proper treatment and ultimately improving pediatric cancer outcomes.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Increasing pediatric radiation oncology capacity in sub-saharan Africa using technology: a pilot of a pediatric radiation oncology virtual training course

Joseph,

Akinsete,

Ajose

et al. 2024

BMC Med Educ

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“…20 Jordan, a middle eastern LMIC, published their 15-year experience using a similar framework, demonstrating its feasibility and adaptability in developing countries. 22,26,27 Philippine training programs, through the national society, can consider evolving the training curriculum to adopt a competency-based framework that approximates global educational standards without necessarily being resource-intensive. Fundamentally, that includes revisiting existing residency performance metrics such as case logs, examinations, and informal evaluations to ensure that they are appropriate, reliable, and standardized.…”

Section: Discussionmentioning

confidence: 99%

Radiation Oncology Training in the Philippines: Bridging Gaps for Improved Cancer Care in Low- and Middle-Income Countries

Jacomina,

Agas,

Benedicto

et al. 2024

JCO Glob Oncol

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PURPOSE Radiation oncology in the Philippines, a large lower- and middle-income country in Southeast Asia, is facing a critical shortage in manpower, with only 113 radiation oncologists (ROs) over 55 radiotherapy (RT) centers serving 100 million population. Paramount to workforce expansion is ensuring that training programs can produce adequately trained specialists. In this study, we describe the current state of radiation oncology training programs in the Philippines. METHODS This is a cross-sectional observational analysis of the nine radiation oncology residency training programs in the Philippines. Data were collected from a survey of the program directors, the Philippine Radiation Oncology Society database, and a PubMed literature search. RESULTS Eight of the nine programs are in the National Capital Region. Since program standardization in 2005, there have been 82 four-year residency graduates, with up to 18 new graduates annually. Faculty-to-trainee ratio ranges from 0.5 to 2.67. In terms of technology, all programs have intensity-modulated RT and high-dose-rate brachytherapy, but only six are equipped with computed tomography–based image guidance and stereotactic capabilities. Clinical education schemes vary per institution regarding curriculum implementation, resident activities, and methods of evaluation. Required resident case logs are not met for lung, GI, genitourinary, bone and soft tissue, and hematologic malignancies. In total, there are only 22 resident-led publications from 10 unique individuals in two training programs. CONCLUSION Program expansions are warranted to meet the projected demand for ROs in the Philippines, but training programs must first improve key aspects of staffing, technology, clinical education, and research. Addressing training challenges related to resource limitations necessitates local and international collaborations with higher-capacity centers to bridge gaps for continued quality improvement with the aim of ultimately delivering better overall cancer care.

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“…Notable challenges with communication among collaborators include time zone differences, language barriers, cultural practices, and scheduling difficulties. [25][26][27] The remote environment has eased some of these obstacles using virtual meetings and telehealth tools. Collaborators in LMICs often struggle with lack of resources, poor health care infrastructure, high patient volume, minimal ancillary support, ethical challenges, political uncertainty, and provider burnout.…”

Section: Discussionmentioning

confidence: 99%

Establishment of Twinning Partnership to Improve Pediatric Radiotherapy Outcomes Globally

Ali,

Amare,

Fekadu

et al. 2024

JCO Glob Oncol

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PURPOSE Pediatric radiotherapy is a necessary and challenging component of oncologic care for children in low- and middle-income countries (LMICs). Collaboration between institutions in LMICs and high-income countries (HICs) has been shown to be effective in improving oncologic treatment outcomes; however, literature regarding pediatric radiotherapy twinning partnerships is limited. METHODS Emory University has a long-standing twinning collaboration with Tikur Anbessa Specialized Hospital (TASH) for certain medical specialties. After securing institutional funding, a faculty member and a resident from the Emory University Department of Radiation Oncology set out to establish a twinning program with TASH for pediatric radiotherapy. RESULTS Emory and TASH faculty and residents established initial communications virtually via email and video correspondence. TASH residents and faculty completed surveys regarding pediatric radiotherapy institutional and educational needs to outline goals of collaboration. Five lectures and case-based practicums were identified focused on Wilms tumor, medulloblastoma, rhabdomyosarcoma, Hodgkin lymphoma, and palliative radiotherapy. The Emory team then conducted a visit to TASH during which lectures and practicums were delivered. The Emory team directly observed and guided simulation and treatment planning procedures. TASH residents practiced decision making, simulation, contouring, and field placement for Wilms tumor cases on the basis of didactics and feedback provided by the Emory team. Additionally, a needs assessment regarding pediatric oncologic resources was completed. Clinical care pathways and standard operating procedures were drafted by collaborators. Virtual peer-review sessions were established to continue collaborations abroad and plan for next in-person visit. CONCLUSION Collaborative efforts by global experts have helped to establish and improve treatment protocols for childhood cancer. The presented twinning experience may serve as a model for other LMIC and HIC centers for establishing similar partnerships.

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Remote Global Radiation Oncology Education and Training: A Pathway to Increase Access to High-Quality Radiation Therapy Services in Low- and Middle-Income Countries

Cited by 5 publications

References 20 publications

Increasing pediatric radiation oncology capacity in sub-saharan Africa using technology: a pilot of a pediatric radiation oncology virtual training course

Increasing pediatric radiation oncology capacity in sub-saharan Africa using technology: a pilot of a pediatric radiation oncology virtual training course

Radiation Oncology Training in the Philippines: Bridging Gaps for Improved Cancer Care in Low- and Middle-Income Countries

Establishment of Twinning Partnership to Improve Pediatric Radiotherapy Outcomes Globally

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