Authors: Gemma Westcott, Future Science Group
According to a Commission presented at the 2015 European Congress in Vienna, Austria (25–29 September) and published in The Lancet Oncology, a significant underinvestment in radiotherapy resources is resulting in widespread deaths that are potentially preventable. The Commission highlights the reality of global radiotherapy services country-by-country and presents the costs for bridging the gap in access to effective treatment.
Up to 60% of cancer patients will require radiotherapy at some point following diagnosis. Currently, only 40–60% cancer patients have access to radiotherapy; however, estimates from the recent Commission predict that 12 million patients could benefit from radiotherapy in the year 2035 if access and investment was to be improved.
In low-income countries, up to nine out of ten individuals do not have access to radiotherapy resources. Forty countries in the world have no radiotherapy facilities at all and facilities in Africa are almost non-existent.
With the rapid rise of cancer in low-and middle income countries (LMIC), scarce radiotherapy services could have enormous implications for the poor.
Findings from the Commission have revealed that an underinvestment in radiotherapy resources has already resulted in millions of unnecessary deaths. Yet, to meet the target of treating those 12 million cancer patients worldwide in 2035, 204 million factions of radiotherapy will be needed.
Although the deficit is great, the Commission states that the cost per-fraction is not only cost-effective, but low compared to the prices of new cancer drugs that are coming on to the market.
By investing US $184 billion, or with efficiency improvements at a cost of US$97 billion, the Commission predicts that all patients in LMICs could have access to radiotherapy by 2035. This would have a potential health benefit of saving 27 million life years as well a potential economic saving of US$278–365 billion over the next 20 years.
Rifat Atun, Commission author and Professor at Harvard T.H. Chan School of Public Health, Harvard University (MA, USA) commented: “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.”
“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.”
Six key targets have been set by the Commission:
1) 80% of countries to have comprehensive cancer plans that include radiotherapy.
2) Each LMIC to create one new centre for treatment and training.
3) 80% of LMICs to include radiotherapy services in their universal health coverage plans.
4) A 25% increase in radiotherapy treatment capacity.
5) LMICs to train 7500 radiation oncologists, 20000 radiotherapy radiographers, and 6000 medical physicists.
6) US$46 billion of upfront investment to be raised to establish radiotherapy infrastructure and training in LMICs (with help from international banks and the private sector).
While a large initial investment will be required to reinforce radiotherapy as an essential global cancer control service, it is thought that the health and economic benefits will be realised in just 10–15 years, similar to the advancements made in HIV/AIDS and malaria.
Atun concluded: “The time has come to agree and implement immediate actions to tackle the global shortfall in radiotherapy services and the crisis of access to this highly effective treatment.”
Sources: Atun R, Jaffray DA, Barton MB et al. Responding to the cancer crisis: expanding global access to radiotherapy. Lancet Oncol. 16(10), (2015); ECCO press release