Radiotherapy prioritization in 143 national cancer control plans: Correlation with radiotherapy machine availability, geography and income level

Brooke E Wilson; Andrew Oar; Danielle Rodin; Freddie Bray; Jacques Ferlay; Alfredo Polo; Josep M Borras; Jean-Marc Bourque; Monica Malik; Fabio Ynoe de Moraes; Yolande Lievens; Lisa M Stevens; Eduardo Zubizarreta; Mei Ling Yap

doi:10.1016/j.radonc.2022.09.001

Radiotherapy prioritization in 143 national cancer control plans: Correlation with radiotherapy machine availability, geography and income level

Radiother Oncol. 2022 Nov:176:83-91. doi: 10.1016/j.radonc.2022.09.001. Epub 2022 Sep 14.

Authors

Affiliations

¹ Collaboration for Cancer Outcomes, Research and Evaluation, South-West Clinical School, University of New South Wales, Liverpool, NSW, Australia; Department of Oncology, Queens University, Kingston, Ontario, Canada. Electronic address: brooke.wilson@kingstonhsc.ca.
² Icon Cancer Centre, Gold Coast University Hospital, Gold Coast, QLD, Australia.
³ Global Cancer Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.
⁴ Cancer Surveillance Branch, International Agency for Cancer Research, Lyon, France.
⁵ Applied Radiation Biology and Radiotherapy Section, International Atomic Energy Agency, Vienna, Austria.
⁶ Department of Clinical Sciences and IDIBELL, University of Barcelona, Barcelona, Spain.
⁷ Division of Radiation Oncology, University of Ottawa, Ottawa, Ontario, Canada; Radiation Oncology, Montreal University Hospital Centre, Montreal, Canada.
⁸ Department of Radiation Oncology, Nizam's Institute of Medical Sciences, Hyderabad, India.
⁹ Radiation Oncology Department, Ghent University Hospital and Ghent University, Ghent, Belgium.
¹⁰ Programme of Action for Cancer Therapy, International Atomic Energy Agency, Vienna, Austria.
¹¹ Collaboration for Cancer Outcomes, Research and Evaluation, South-West Clinical School, University of New South Wales, Liverpool, NSW, Australia; Liverpool Cancer Centre and Macarthur Cancer Therapy Centre, Western Sydney University, Campbelltown, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia; The George Institute for Global Health, UNSW Sydney, Newtown, New South Wales, Australia.

PMID: 36113775
DOI: 10.1016/j.radonc.2022.09.001

Abstract

Background: In 2015, the Global Task Force on Radiotherapy for Cancer Control (GTFRCC) called for 80% of National Cancer Control Plans (NCCP) to include radiotherapy by 2020. As part of the ongoing ESTRO Global Impact of Radiotherapy in Oncology (GIRO) project, we assessed whether inclusion of radiotherapy in NCCPs correlates with radiotherapy machine availability, national income, and geographic region.

Methods: A previously validated checklist was used to determine whether radiotherapy was included in each country's NCCP. We applied the CCORE optimal radiotherapy utilisation model to the GLOBOCAN 2020 data to estimate the demand for radiotherapy and compared this to the International Atomic Energy Agency (IAEA) Directory of Radiotherapy Centres (DIRAC) supply data, stratifying by income level and world region. World regions were defined according to the IAEA.

Findings: Complete data (including GLOBOCAN 2020, DIRAC and NCCP) was available for 143 countries. Over half (55%, n = 79) included a radiotherapy-specific checklist item within the plan. Countries which included radiotherapy services planning in their NCCP had a higher median number of machines (1.68 vs 0.75 machines/1000 patients needing radiotherapy, p < 0.001). There was significant regional and income-level heterogeneity in the inclusion of radiotherapy-related items in NCCPs. Low-income and Asia-Pacific countries were least likely to include radiation oncology services planning in their NCCP (p = 0.06 and p = 0.003, respectively). Few countries in the Asia-Pacific (18.6%) had a plan to develop or maintain radiation services, compared to 57% of countries in Europe.

Interpretation: Only 55% of current NCCPs included any information regarding radiotherapy, below the GTFRCC's target of 80%. Prioritisation of radiotherapy in NCCPs was correlated with radiotherapy machine availability. There was regional and income-level heterogeneity regarding the inclusion of specific radiotherapy checklist items in the NCCPs. Ongoing efforts are needed to promote the inclusion of radiotherapy in future iterations of NCCPs in order to improve global access to radiation treatment.

Funding: No direct funding was used in this research.

Keywords: Global health; Global oncology; National cancer care plans; Radiation oncology; Radiotherapy.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Delivery of Health Care
Geography
Humans
International Agencies
Neoplasms* / radiotherapy
Radiation Oncology*
Radiotherapy