ECC 2015: Tackling the Global Shortfall in Radiotherapy
Millions of people are unable to receive necessary treatment worldwide because of a chronic underinvestment in radiotherapy resources, according to a major new Commission on access to radiotherapy, published in by Atun et al in The Lancet Oncology, and presented at the 2015 European Cancer Congress in Vienna, Austria (Abstract 2LBA).
New estimates produced for the Commission reveal that 204 million fractions of radiotherapy will be needed to treat the 12 million cancer patients worldwide who could benefit from treatment in 2035. Despite the enormity of the problem, said the authors, the cost per fraction is very low compared to the high price of many new cancer drugs.
The Commission estimates that full access to radiotherapy could be achieved for all patients in need in low- and middle-income countries by 2035 for US$97 billion, with potential health benefits of 27 million life-years saved and economic benefits ranging from US$278 billion to US$365 billion over the next 20 years.
“There is a widespread misconception that the costs of providing radiotherapy put it beyond the reach of all but the richest countries. Nothing could be further from the truth”, said Commission author Rifat Atun, MBBS, MBA, FRCGP, FFPH, FRCP, Professor of Global Health Systems at Harvard School of Public Health. “Our work for this Commission clearly shows that not only can this essential service be deployed safely and high-quality treatment delivered in low- and middle-income countries, but that scale-up of radiotherapy capacity is a feasible and highly cost-effective investment.”
Large Disparity Between Need and Availability
The Commission exposed the reality of radiotherapy services on a country-by-country basis across the world and, for the first time, calculated the costs and benefits of meeting the worldwide shortfall in resources and bridging the gap in access to effective treatment.
Radiotherapy treatment is essential for the cure and palliation of most cancers, including those of the breast, lung, prostate, head and neck, and cervix. Up to 60% of all cancer patients will require radiotherapy at some point. New estimates produced for the Commission find that in 2035 over 12 million new cancer patients could benefit from radiotherapy treatment.
Yet, worldwide access to radiotherapy is unacceptably low, with only 40% to 60% of cancer patients having access to this vital treatment. Even in high-income countries like Canada, Australia, and the United Kingdom, numbers of radiotherapy facilities, equipment, and trained staff are inadequate.
Access is worst in low-income countries, where as many as 9 out of 10 people in need cannot access radiotherapy treatment. The problem of access is especially acute in Africa, where in most countries radiotherapy treatment is virtually nonexistent—40 countries have no radiotherapy facilities at all.
Radiotherapy has, until now, been overlooked as a critical need for the health of the world’s population and is often the last resource to be considered when planning cancer control systems. Persistent underinvestment in radiotherapy resources has already resulted in millions of unnecessary deaths.
“Cancer is rapidly rising in low- and middle-income countries, and it overwhelmingly affects the poor,” said Dr. Atun. “This has huge implications for the already scarce radiotherapy services and for people with cancer, health systems, economic development, and the drive to reduce poverty.”
Benefits and Goals
New estimates produced for the Commission show that access to radiotherapy could be scaled up to acceptable levels across all low- and middle-income countries by 2035 with an investment of US$184 billion, or with efficiency improvements at a cost of US$97 billion.
The Commission concluded by calling for six key targets to be met:
By 2020:
- 80% of countries to have comprehensive cancer plans that include radiotherapy
- Each low- and middle-income country to create one new center for treatment and training
- 80% of low- and middle-income countries to include radiotherapy services in their universal health coverage plans
By 2025:
- a 25% increase in radiotherapy treatment capacity
- low- and middle-income countries to train 7,500 radiation oncologists, 20,000 radiotherapy radiographers, and 6,000 medical physicists
- US$46 billion of upfront investment to be raised to establish radiotherapy infrastructure and training in low- and middle-income countries (with help from international banks and the private sector)
According to Co-Commissioner and Co-Chair of the UICC Global Task Force on Radiotherapy for Cancer Control, Mary Gospodarowicz, MD, FRCR, FRCPC, “The evidence outlined in the Commission reinforces the case for investing in radiotherapy as an essential component of cancer control. The building of radiotherapy capacity will require large initial investment. However, the treatment is more cost-effective than chemotherapy and surgery for treating cancer, and the health and economic benefits will be realized in just 10 to 15 years. To justify the investment, we only need to look at the remarkable progress made in tackling the enormous challenges of HIV/AIDS and malaria. This gives us the hope and confidence that the same success can be achieved with cancer control and radiotherapy.”
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
