Making the case for radiotherapy investment

 

 

Role of radiotherapy in cancer control

Key messages

• Radiotherapy is an essential technology for the treatment and care of the most common cancers globally including cervical, breast, colorectal, head and neck cancers
• On average radiotherapy is recommended for 52% of cancer patients[1] however amongst low- and middle income countries (LMICs) this figure is likely to be higher due to the most prevalent types of cancer in the countries and late stage presentation by patients
• Radiotherapy is marked by global inequities, 80% of cancer patients live in LMICs, but only have access to around 5% of radiotherapy resources[2]. In practical terms, this means that more than 90% of the cancer patients in low-income countries lack access to treatment[3].

Resources

• Read more about the Expanding global access to radiotherapy commission
• Four-page summary of the Lancet Oncology Commission  Access to essential radiotherapy: lives saved and economic returns

Understanding the global demand for radiotherapy

Key messages

The Global Taskforce on Radiotherapy for Cancer Control (GTFRCC) was established to determine the global burden of cancer amenable to treatment with radiotherapy; the investment needed to bridge the current gaps in radiotherapy access to meet this need; and what human and financial benefits would be generated from this.

The GTFRCC found that:

• By 2035 an estimated 12 million cancer patients would benefit from radiotherapy
• In 2012 an estimated 119 million fractions (treatment sessions) were needed to meet global demand (around 18.4 fractions per patient)
• In 2035 this figure is expected to rise to 204 million fractions, meeting this need would have the potential to save 950,000 lives and help locally control cancer for 2.5 million people globally
• There are currently 4,191 radiotherapy machines across 2,602 centres in LMICs, to meet demands in 2035 an estimated 8,400 further radiotherapy machines will be required. However significant improvements could also be made in improving the utilisation of existing radiotherapy facilities.

Understanding the commission: developing the Global Task Force on Radiotherapy for Cancer Control

Dr David Jaffray, Head of the GTFRCC Secretariat, presents on why the GTFRCC was established, how and why the aims were developed and are relevant to the global health community. David also talks through how the team reached their results, their implications for the global cancer community and next steps.

• The team from the journal Clinical Oncology have created two podcasts entitled Global access to radiotherapy: the silent crisis to review the findings of the GTFRCC, the current lack of radiotherapy provision in LMICs, innovative solutions to reduce global inequality and lessons learned from key case studies. 
• Explore the IAEA’s map of radiotherapy provision to understand availability in your country or region. 

 

Making the case for investment in radiotherapy

Key messages

• To establish a single radiotherapy centre (consisting of two radiotherapy units and supporting facilities) the capital investment was estimated at USD 5 million, this in turn could benefit 800-1,000 cancer patients per year
• the global investment needed to incrementally scale up radiotherapy across LMICs by 2035 was estimated to be USD 184 billion, but this number was reduced to USD 98.6 billion when efficiency savings were made 
• By comparison the cost of inadequately treated cancer globally had already reached USD 895 billion in 2010[4]
• Scale-up costs included the capital expenses of developing new facilities including building, equipment, and training new staff; as well as operating costs associated with salaries and equipment maintenance by country
• Investing in scaling-up radiotherapy has potential to save 26.9m life years across LMICs and deliver economic returns of USD 278.1 billion
• Models suggests that investments in developing radiotherapy capacity are expected to be recouped within 10-15 years across LMICs.

Making the case for investment: the key messages

Dr Danielle Rodin runs through the investment case for radiotherapy and explores the long term costs and benefits of scaling up radiotherapy investment for high-, middle-, and low-income countries alike.

• Read more about the Expanding global access to radiotherapy commission
• Learn more about building investment cases for health from the Global Health 2035 Lancet Commission, including the returns to investing in health

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Scaling up Radiotherapy: a call to action

The Global Taskforce on Radiotherapy for Cancer Control (GTFRCC) concluded that radiotherapy is an important, cost effective and feasible investment for all countries. To help achieve improved access to radiotherapy by 2035 the GTFRCC identified a five-point call to action:

1. Incorporate radiotherapy into population-based cancer control plans

• Does your country have a cancer control plan that includes radiotherapy? Review current national cancer control plans on the ICCP portal
• Review cancer planning tools and request technical assistance from the International Cancer Control Partnership (ICCP) 

2. Increase radiotherapy treatment capacity

• Learn more about what support is available to develop radiotherapy treatment capacities, including IAEA support:
  • PACT team and imPACT missions
  • The UNIATF project on cervical cancer
  • Quality assurance and safety audits
• Review the training modules available through the VUCC net
• Explore the tools and publications available on the Human Health campus and learn more about virtual tumour boards such as AFRONET
   
• Learn more about delivering radiotherapy through the February 2017 special edition of Clinical Oncology

3.Train radiation oncologists, radiation technologists, and medical physicists in LMICs

• Learn more about the role of professional societies in supporting scale-up of radiotherapy such as ESTRO’s HERO project and EU training
   
• Find out more about Global RT a movement amongst young cancer leaders to drive forward action on radiotherapy

 

4. Invest to establish radiotherapy infrastructure and training in LMICs

5. Include radiotherapy services as part of the universal health coverage plans in 80% of LMICs by 2020

 

Taking this forward: what are the next steps?

Prof. Mary Gospodarowicz, GTFRCC Secretariat member and Medical Director at the Princess Margaret Cancer Centre explores the commission’s 5-point call to action.

Resources

• World Cancer Declaration Progress Report 2016 – read more about how countries are developing radiotherapy services, and how UICC members are supporting these efforts