The Benefits of Providing External Beam Radiotherapy in Low- and Middle-income Countries

Yap, Mei Ling; Hanna, Timothy P.; Shafiq, Jesmin; Ferlay, Jacques; Bray, Freddie; Delaney, Geoff P.

doi:10.1016/j.clon.2016.11.003

Cited by 36 publications

(37 citation statements)

References 27 publications

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“…Multiple opportunities for regional training, mentoring and network building have been created. They include Africa Radiation Oncology Network (AFRONET) and Virtual University for Cancer Control by IAEA and “train‐the‐trainers” approach by Radiating Hope, RANZCR, and Medical Physics for World Benefit . Links with radiotherapy centers in HICs are vital in improving technical support .…”

Section: Discussionmentioning

confidence: 99%

“…They include Africa Radiation Oncology Network (AFRONET) and Virtual University for Cancer Control by IAEA and "train-the-trainers" approach by Radiating Hope, RANZCR, and Medical Physics for World Benefit. 3,[30][31][32] Links with radiotherapy centers in HICs are vital in improving technical support. 2 The findings confirmed those of previous evidence that depending on overseas training is unsustainable.…”

Section: Discussionmentioning

confidence: 99%

“…Achieving universal radiotherapy access is desirable, and global advocacy and supports are crucial . For more than six decades, the international community has worked collaboratively with LMICs to improve radiotherapy access .…”

Section: Introductionmentioning

confidence: 99%

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Experiences of barriers and facilitators to establishing and sustaining radiotherapy services in low‐ and middle‐income countries: A qualitative study

Donkor

Luckett

Aranda

et al. 2020

Asia-Pac J Clncl Oncology

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Aims The factors contributing to the establishment of high‐quality radiotherapy services in low‐ and middle‐income countries (LMICs) are poorly understood. The aim was to identify and describe barriers and facilitators to establishing and sustaining high‐quality and accessible radiotherapy services in LMICs based on the experience of successful and unsuccessful attempts. Methods An exploratory‐descriptive qualitative study using semistructured telephone interviews was undertaken. Purposive and snowball sampling techniques were used to recruit participants. The World Health Organization Innovative Care for Chronic Conditions Framework informed the interview guide. A constant comparative data analysis approach was adopted. Findings Seventeen participants were interviewed. Ten were working permanently in nine LMICs and seven were permanently employed in four high‐income countries. Three themes were developed: committing to a vision of improving cancer care; making it happen and sustaining a safe service; and leveraging off radiotherapy to strengthen integrated cancer care. Identified barriers included lack of political leadership continuity, lack of a coordinated advocacy effort, non‐Member State of the IAEA, lack of reliable epidemiological data, lack of a comprehensive budget and lack of local expertise. Facilitators identified included strong political support, vision champion, availability of a regulator, costed cancer control plan, diversified sources of funding, responsible project manager, adoption of evidence‐based practice, strategic partnerships, motivation to provide patient‐centered care, and availability of supportive technology. Conclusions Assessing the level of readiness to establish and sustain a radiotherapy service is highly recommended. Future research is recommended to develop a readiness assessment tool for radiotherapy services implementation at LMICs.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Experiences of barriers and facilitators to establishing and sustaining radiotherapy services in low‐ and middle‐income countries: A qualitative study

Donkor

Luckett

Aranda

et al. 2020

Asia-Pac J Clncl Oncology

View full text Add to dashboard Cite

show abstract

“…Implementing evidence-based cancer care, particularly essential radiotherapy services, in LMICs is challenging. It is estimated that at least half of cancer patients will require radiotherapy to cure, improve local tumour control, achieve symptom control or improve their quality of life (1)(2)(3). Access to radiotherapy is a basic human right for people affected by cancer.…”

Section: Introductionmentioning

confidence: 99%

Development of the ‘REadiness SElf-Assessment (RESEA) Guide’ to assist low and middle-income countries with establishing safe and sustainable radiotherapy services: a pragmatic sequential mixed qualitative methods project

Donkor

Luckett

Aranda

et al. 2020

Preprint

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Background: Improving access to radiotherapy services in low and middle-income countries (LMICs) is challenging. Many LMICs’ radiotherapy initiatives fail because of multi-faceted barriers leading to significant wastage of scarce resources. Supporting LMICs to self-assess their readiness for establishing radiotherapy services will help to improve cancer outcomes by ensuring safe, effective and sustainable evidenced-based cancer care. The aim of the study was to develop practical guidance for LMICs on self-assessing their readiness to establish safe and sustainable radiotherapy services.Methods: The Access to Radiotherapy for Cancer treatment (ARC) Project was a pragmatic sequential mixed qualitative methods design underpinned by the World Health Organisation’s ‘Innovative Care for Chronic Conditions Framework’ and ‘Health System Building Blocks Framework for Action’ conceptual frameworks. This paper reports on the process of overall data integration and meta-inference from previously published components comprising a systematic review and two-part qualitative study (semi-structured interviews and a participant validation process). The meta-inferences enabled a series of radiotherapy readiness self-assessment requirements to be generated, formalised as a REadiness SElf-Assessment (RESEA) Guide’ for use by LMICs.Findings: The meta-inferences identified a large number of factors that acted as facilitators and/or barriers, depending on the situation. ‘Commitment’, ‘cooperation’, ‘capacity’ and ‘catalyst’ were identified as the key domains enabling development of radiotherapy services. Across these four domains, the RESEA Guide included 37 requirements and 120 readiness questions that LMICs need to consider and answer as part of establishing a new radiotherapy service.Conclusions: The RESEA Guide provides a new resource for LMICs to self-assess their capacity to establish safe and sustainable radiotherapy services. Future evaluation of the acceptability and feasibility of the RESEA Guide is needed to inform further refinements.

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“…Investment in radiotherapy services over a 20-year period could result in a net benefit of $38.5 billion in LMICs with an absolute population benefit of 31% in 5-year local control of cervical cancer and 17% in overall survival. 14 Tumor registries to measure disease control and provide a platform for clinical research in LMICs are needed to prioritize high-impact interventions in these settings. 5 This has been difficult without broad-scope digitization, technology, and consistent funding for personnel, with LMICs instead relying on already limited administrative staff.…”

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confidence: 99%

A global care package for women: Gender‐neutral human papillomavirus eradication

Ueda

Temkin

2020

Cancer

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The role of human papillomavirus (HPV) virus as the cause of cervical cancer has long been established. The infectious etiology and long latency period made a prevention, screening, mitigation, and treatment paradigm typically implemented for communicable diseases a rational strategy for the worldwide eradication of cervical cancer (Fig. 1). 1 The development of an effective and safe vaccine against the HPV virus in the early 2000s offered the last key component necessary for this plan to be enacted. Before the availability of the HPV vaccine, the disease had already become uncommon in many high-income countries (HICs) through widespread cytologic screening programs and the availability of treatment for preinvasive disease. However, 14 years after the vaccine was approved for use in the United States, cervical cancer continues to be the most commonly diagnosed cancer among women in 28 countries and the leading cause of cancer death in 42 countries, including the majority in sub-Saharan Africa and Southeastern Asia. 2 In every setting worldwide, cervical cancer disproportionately affects poor, vulnerable, and minority populations. Those women most susceptible to this disease are those with the fewest resources to contend with it after a diagnosis. In this issue of Cancer, Gatti et al 3 present their assessment of the worldwide availability of health services relevant to cervical cancer. Despite clearly defined comprehensive packages, significant deficits were identified. Only 21% and 19.1% of nations provided all required interventions to control cervical cancer from their "Essential Cancer Package" and "Primary Care Package," respectively. Access to items within the packages unsurprisingly tracked with income. A complex, multifaceted collection of barriers contributes to this persistent and growing discrepancy between the vision of cervical cancer elimination and the reality on the ground. Implementation of the components evaluated in the 2 packages, including vaccination, screening, treatment, and monitoring, is unsatisfactory in all resource settings, but particularly tenacious obstacles persist in low-resource settings. We have been globally complacent about the impact of disparities in health care spending, access to care, and resource allocation and their impact on cervical cancer prevention, screening, and treatment across HICs versus low-income countries (LICs). These cataclysmic inequities have been often and well described. 4,5 The acceptability and delivery of HPV vaccination have been slower than anticipated, particularly in lower income countries. Among 55 vaccine projects and 8 national programs in 37 lower middle-income countries (LMICs) started between January 2007 and 2015, only 70% achieved first-dose coverage. 6 Even when the financial hurdles associated with vaccination can be overcome, written parental consent results in lower coverage, and fears of adverse effects and a lack of project awareness and goals require interactive communication to dispel rumors. Challenges in screening in lower inc...

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The Benefits of Providing External Beam Radiotherapy in Low- and Middle-income Countries

Cited by 36 publications

References 27 publications

Experiences of barriers and facilitators to establishing and sustaining radiotherapy services in low‐ and middle‐income countries: A qualitative study

Experiences of barriers and facilitators to establishing and sustaining radiotherapy services in low‐ and middle‐income countries: A qualitative study

Development of the ‘REadiness SElf-Assessment (RESEA) Guide’ to assist low and middle-income countries with establishing safe and sustainable radiotherapy services: a pragmatic sequential mixed qualitative methods project

A global care package for women: Gender‐neutral human papillomavirus eradication

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