Post on 31-Jul-2020
Radiotherapy in cancer Radiotherapy in cancer control in lowcontrol in low-- and and
middlemiddle income countriesincome countriesmiddlemiddle--income countriesincome countries
XRT in LMI countriesXRT in LMI countriesXRT in LMI countriesXRT in LMI countries
What is LMI?What is LMI?What is LMI?What is LMI?Cancer in LMICancer in LMINeed for XRTNeed for XRTNeed for XRTNeed for XRTCost and costCost and cost--effectivenesseffectivenessCurrent state of XRT in LMI countriesCurrent state of XRT in LMI countriesCurrent state of XRT in LMI countriesCurrent state of XRT in LMI countriesCase studiesCase studies•• Breast Breast •• Breast Breast •• CervixCervix•• LungLungLungLung
LMI countriesLMI countriesLMI countriesLMI countries
IncomeIncome Gross National Income Gross National Income per person per year (US$)per person per year (US$)per person per year (US$)per person per year (US$)
Low Low 765765
MiddleMiddle 766 766 –– 9,3859,385
HighHigh 9,3869,386
World Bank IncomesUpper middle income (34)Lower middle income (54)( )Low income (60)High income: OECD (24)High income: nonOECD (26)
Cancer in LMI countriesCancer in LMI countriesCancer in LMI countriesCancer in LMI countries
10 illi b 201010 illi b 201010 million new cases by 201010 million new cases by 2010
>50% of all cancers occur in LMI>50% of all cancers occur in LMI
70% by 202070% by 2020
New cases of cancer New cases of cancer
Globocan 2002
Radiotherapy UtilisationRadiotherapy UtilisationRadiotherapy UtilisationRadiotherapy Utilisation
52% of all cancer patients need 52% of all cancer patients need 52% of all cancer patients need 52% of all cancer patients need radiotherapy at least onceradiotherapy at least once86% curative or adjuvant86% curative or adjuvant86% cu at e o adju a t86% cu at e o adju a t2020--25% may need >1 treatment episode25% may need >1 treatment episodeRTU likely to be higherRTU likely to be higherRTU likely to be higherRTU likely to be higher•• More advanced stageMore advanced stage•• Less surgical expertiseLess surgical expertiseg pg p
The need for radiotherapyThe need for radiotherapyThe need for radiotherapy The need for radiotherapy
Russia
Latvia
Iceland
Estonia
Canada
Uzbekistan
United States
United Kingdom
United Arab Emirates
Ukraine
Turkey
Tunisia
Tajikistan
SyriaSpain
Slovenia
Slovakia
Serbia
Saudi Arabia
Romania
Qatar
Portugal
Poland
Pakistan
NigerMyanmar
Morocco
MongoliaMoldova
Mexico
Malta
Mali
Macedonia
Lithuania
Libya
Lebanon
Latvia
Kyrgyzstan
Kuwait
Korea Rep.
Korea DPR
Kazakhstan
Jordan
Japan
Jamaica
Ireland
Iraq
India
Hungary
Haiti
Greece
Germany
Georgia
France
Egypt
Dominican Republic
Czech Republic
Cyprus
Cuba
Croatia
China
BulgariaBosnia and Herzegovina
Belarus
Bangladesh
AzerbaijanArmenia
Algeria
Albania
Afghanistan
Zimbabwe
Zambia
Yemen Vietnam
Venezuela
Uganda
Thailand
Tanzania
Sudan
Sri Lanka
Singapore
Sierra Leone
Senegal
Philippines
Peru
P
Panama Nigeria
g
Nicaragua
Namibia
Mauritius
Malaysia
Malawi
Madagascar
Liberia
KenyaIndonesia
HondurasGuatemala
Ghana
Gabon
Ethiopia
EritreaEl Salvador
EcuadorDemocratic Republic of the Congo
Cote D'IvoireCosta Rica
Chad
Central African Republic
Cape Verde
Cameroon
Burkina Faso
Brazil
Botswana
Bolivia
Benin
Angola
% of cases requiring RT
Uruguay
South Africa
Paraguay Namibia
Chile
Australia
Argentina
q g
0 - 0.390.39 - 0.430.43 - 0.470 47 - 0 51
N. Taylor, IAEA 2005
0.47 - 0.510.51 - 0.550.55 - 0.590.59 - 1
Cancer cases needing XRTCancer cases needing XRTCancer cases needing XRTCancer cases needing XRT
Russia
Iceland
Canada
Uzbekistan
United States
United Kingdom
United Arab Emirates
Ukraine
Turkey
Tunisia
Tajikistan
SyriaSpain
Slovenia
Slovakia
Serbia
Saudi Arabia
Romania
Qatar
Portugal
Poland
PakistanMorocco
MongoliaMoldova
Mexico
Malta
Macedonia
Lithuania
Libya
Lebanon
Latvia
Kyrgyzstan
Kuwait
Korea Rep.
Korea DPR
Kazakhstan
Jordan
Japan
Ireland
Iraq
India
Hungary
Greece
Germany
Georgia
France
Estonia
Egypt
Czech Republic
Cyprus
Cuba
Croatia
China
BulgariaBosnia and Herzegovina
Belarus
Bangladesh
AzerbaijanArmenia
Algeria
Albania
Afghanistan
Zimbabwe
Zambia
Yemen Vietnam
Venezuela
Uganda
Thailand
Tanzania
Sudan
Sri Lanka
Singapore
Sierra Leone
Senegal
Philippines
Peru
PanamaNigeria
Niger
Nicaragua
Myanmar
Mali
Malaysia
Malawi
Madagascar
Liberia
Kenya
Jamaica
Indonesia
Honduras
Haiti
Guatemala
Ghana
Gabon
Ethiopia
EritreaEl Salvador
Ecuador
Dominican Republic
Democratic Republic of the Congo
Cote D'Ivoire
Costa Rica
Chad
Central African Republic
Cape Verde
Cameroon
Burkina Faso
Brazil
Bolivia
Benin
AngolaCancer Cases per Million Population Requiring RT
bab e
Uruguay
South Africa
Paraguay Namibia
Mauritius
Chile
Botswana
Australia
Argentina0 - 200200 - 800800 - 1200
N. Taylor, IAEA 20051200 - 16001600 - 20002000 - 20000
CostCostCostCost
BuildingBuilding 3%3%BuildingBuilding 3%3%
EquipmentEquipment 30%30%
StaffStaff 50%50%
MaterialsMaterials 4%4%
OverheadsOverheads 13%13%OverheadsOverheads 13%13%
Kesteloot K, Lievens Y, van der SE. Improved management of radiotherapy departments through accurate cost data. Radiother Oncol 2000; 55(3):251-262.
C b ltC b lt LiLiCobaltCobalt LinacLinac
MachineMachine $480,000$480,000 $1,800,000$1,800,000
MaintenanceMaintenance $1270 to $1270 to $35,680$35,680
$3000 to $3000 to $91,740 $91,740
Cost per Cost per treatmenttreatment
$4.87$4.87 $11$11
Van Der Giessen PH, Alert J, Badri C, Bistrovic M, Deshpande D, Kardamakis D et al. Multinational assessment of some operational costs of teletherapy. Radiother Oncol. 2004;71(3):347-55.
Current status of XRTCurrent status of XRTCurrent status of XRTCurrent status of XRT
24/72 countries with > 1 million 24/72 countries with > 1 million 24/72 countries with > 1 million 24/72 countries with > 1 million people had no XRTpeople had no XRTAverage GNI/ cap US$300 Average GNI/ cap US$300 e age G / cap US$300e age G / cap US$300
All Member States100.000
Europe
10.000
S$ 1
,000
s
Asia & Pacif ic
Central America
South America
Africa
straight line f it
0.100
1.0000.0100 0.1000 1.0000 10.0000 100.0000
GD
P/ca
pita
US
0.010
No. teletherapy units / million population
CervixCervixCervixCervix>80% new cases & deaths >80% new cases & deaths in LMIin LMIin LMIin LMI5050--60% of new cases die of 60% of new cases die of cervix cancercervix cancer
1000 1 0
Incidence Mortality M/I ratio
9191--99% need XRT99% need XRT
60
80
100
d) ra
te p
er 1
00, 0
000.6
0.8
1.0
ence
rat
io*
20
40
stan
derd
ised
(wor
ld
0.2
0.4
Mor
talit
y/In
cide
0
high incomecountries
upper-middleincome
countries
low-middleincome
countries
low incomecountries
Age
s
0.0
Strategies to improve accessStrategies to improve accessStrategies to improve accessStrategies to improve access
PlanningPlanningPlanningPlanningInvestmentInvestmentLi kLi kLinkagesLinkagesAccess to informationAccess to informationEducation about cancerEducation about cancerSafetySafetySafetySafety
PlanningPlanningPlanningPlanning
No “one size fit’s all” planNo “one size fit’s all” planNo one size fit s all planNo one size fit s all plan•• casemixcasemix•• capabilitiescapabilities
100%LiverOvary etc.•• capabilitiescapabilities
70%
80%
90% LeukaemiaThyroidTestisMultiple myelomaMelanoma of skinKidney etc.
40%
50%
60%Corpus uteriOther PharynxPancreasHodgkin's diseaseColon/RectumBrain, nervous system
20%
30%
NasopharynxLarynxOral cavityLungStomachBladderN H d ki l h
0%
10%
EastAfrica
CentralAfrica
NorthernAfrica
SouthernAfrica
WesternAfrica
all Africa
Non-Hodgkin lymphomaOesophagusProstateCervix uteriBreast
InvestmentInvestmentInvestmentInvestment
EquipmentEquipmentEquipmentEquipmentStaffStaffMaintenanceMaintenanceMaintenanceMaintenanceSource Source replacementreplacementreplacementreplacement
LinkagesLinkagesLinkagesLinkages
Many isolated departmentsMany isolated departmentsMany isolated departmentsMany isolated departmentsTrainingTrainingCPDCPDSouth South –– SouthSouthExchangesExchanges•• ProtocolsProtocols•• ProtocolsProtocols•• Staff Staff
Access to informationAccess to informationAccess to informationAccess to information
JournalsJournals $/Gbyte/monthJournalsJournals•• CostCost•• LanguageLanguage
18002000
g gg g•• OnOn--line accessline access
MeetingsMeetings
1500
500
1000
200
500
0US Africa
Education about cancerEducation about cancerEducation about cancerEducation about cancer
Medical studentsMedical studentsMedical studentsMedical studentsRadiation oncology staffRadiation oncology staff•• Regional training centresRegional training centresRegional training centresRegional training centres
Distance learning coursesDistance learning courses
SafetySafetySafetySafety
InterInter--centre dosimetrycentre dosimetryInterInter centre dosimetrycentre dosimetryMaintenance Maintenance Common protocolsCommon protocolsCommon protocolsCommon protocolsSource security Source security
ConclusionsConclusionsConclusionsConclusionsCancer is a major problem in LMICancer is a major problem in LMIj pj pRadiotherapy is essential and viableRadiotherapy is essential and viableCobalt is preferredCobalt is preferredPl iPl iPlanningPlanningInvestmentInvestmentLinkagesLinkagesLinkagesLinkagesInformationInformationEducation Education Education Education SafetySafetyPACTPACT