Access to Modern Radiotherapy Technology in Low- and Middle-Income Countries: Obstacles and Opportunities

Radiotherapy technology is an essential component of the cancer care provided by LMICs. Implementing it in these countries poses unique challenges and provides novel opportunities for improving access to cancer care since it can effectively bridge geographical barriers.

FREMONT, CA: Radiation therapy is an important cancer treatment strategy. Nearly half of all cancer patients need radiotherapy as part of their treatment plan. This is the mainstay of definitive treatment for advanced cancer sites such as the head/neck, cervix, and prostate. Low- and middle-income countries (LMICs) have disproportionately higher rates of these cancers, which tend to be detected earlier when they are inoperable.

Consequently, the demand for radiotherapy in LMICs is even higher, both for definitive and palliative therapy. This is because the localized requirement for radiotherapy is even higher.6 Accordingly, radiotherapy plays a major role in cancer care planning in LMICs. It must be readily available in both quantity and quality. The rapid evolution of radiotherapy technology has influenced therapeutic management across various cancer sites. Still, many barriers prevent the benefits of these advancements from reaching patients with cancer living in the least developed countries.

Clinical outcomes of radiotherapy across cancer sites are affected by the technological status of radiotherapy resources. A growing number of LMICs will see a 70 percent-100 percent increase in locally advanced cancers in the breast, lungs, and head and neck regions as a result of radiotherapy.

With the advent of modern radiotherapy equipment, technological advancements have radically altered the 

delivery of radiation for these cancers over conventional radiotherapy based on telecobalt.Technology has significantly contributed to reducing treatment-related toxicity and improving treatment tolerance. Intensity-modulated radiation treatment (IMRT) in treating head/neck cancer reduces the incidence and severity of late treatment-related morbidities, including dysphagia, xerostomia, weight loss, trismus, fibrosis, and hearing impairments.

In high-income and low-income countries, many barriers to accessing high-quality radiotherapy technologies have been identified. Several patient and physician factors, such as age, comorbid conditions, and lower awareness, were identified as significant factors affecting the lower utilization of IMRT/image-guided radiotherapy in European nations, including physician referral bias, physician preferences, and geographical factors (distance from residence, imbalanced distribution of treatment centers).

It is essential to be aware of barriers to technological access, both at the policy and decision-making levels, as well as to understand the value of high-quality radiotherapy at all policy- and decision-making levels. There is a strong need to involve clinical experts in the policy definition process, as well as a ground-level estimation of future technological needs at present and in the future, to achieve the desired access to quality radiotherapy.

With modern techniques such as intensity modulation, image guidance, stereotactic ablation, and integration of radiological and functional imaging into radiotherapy planning, radiation oncology has changed its face as an integral component of cancer treatment.