Why Do Radiotherapy Access Gaps Persist Even in Wealthy Countries?

Even in high-income countries, many patients who could benefit from radiotherapy never receive it. Sandra Turner, MBBS, PhD, a radiation oncologist and clinical professor at the University of Sydney and co-chair of World Radiotherapy Awareness Day, has spent much of her career advocating for greater access to and awareness of radiotherapy.

Turner spoke with Brandon Mancini, MD, MBA, FACRO, host of RadOnc on the Run, about how far the field still has to go in closing global access gaps. Mancini is the medical director at Bold Advanced Medical Future Health, a clinical associate professor in the Department of Radiology at Michigan State University College of Human Medicine, and the editor at large for RadOnc Review, a supplement of the journal ONCOLOGY^®.

Hear the full conversation and learn more about World Radiotherapy Awareness Day here.

Transcript:

Mancini: You’ve said every patient deserves the benefit of high-quality radiotherapy, meaning access for everyone who needs it. How far do you feel we are from achieving that goal globally?

Turner: Good question. It’s difficult with awareness campaigns to draw a direct line between what you’re doing and the impact. You have to have a bit of blind faith that if you don’t keep making noise about things, agitating, getting the messaging out, and influencing communities and politicians, you can only go backwards, particularly in a world where we know there’s a tsunami of cancer coming our way, growing all the time with the aging population.

As you said,there’s still a large gap, even in wealthy countries, in people accessing radiotherapy. Some of that isn’t due to services; there might be enough machines, but it’s myths, misconceptions, inadequate referral pathways, poor funding, geographical distance, and all those [factors] that come into play even in wealthier countries. In Australia, for instance, the gap is that, at the moment, about 1 in 3 patients access radiotherapy, when it should be about 1 in 2, or even more, now that more people are being retreated and we know it’s safe to give retreatment. That’s in a high-socioeconomic country.

In some parts of the world, we know that millions of people are missing out and lives are lost. There are still 20 countries in Africa that don’t have a single radiation machine, and there are countries like Nigeria, with tens of millions of people in their population, that may at any one time only have a handful of working linear accelerators. In some places, the gap is a crisis. In others, it is not so bad. But I don’t think there’s any country in the world where there isn’t more we can do to improve understanding of and access to radiotherapy.

At the moment, when you look across changes over, say, 10 years of radiotherapy utilization, the gap is probably similar in most countries to what it was previously. I don’t think we’re ever going to completely have the need met by the services. But the fact that the gap is stable is perhaps some indication that, while cancer incidence keeps growing, we’re making some headway.