Geographic Accessibility and Availability of Radiotherapy in Ghana

Abstract

ImportanceRadiotherapy is critical for comprehensive cancer care, but there are large gaps in access. Within Ghana, data on radiotherapy availability and on the relationship between distance and access are unknown.ObjectivesTo estimate the gaps in radiotherapy machine availability in Ghana and to describe the association between distance and access to care.Design, Setting, and ParticipantsThis is a cross-sectional, population-based study of radiotherapy delivery in Ghana in 2020 and model-based analysis of radiotherapy demand and the radiotherapy utilization rate (RUR) using the Global Task Force on Radiotherapy for Cancer Control investment framework.ExposuresReceipt of radiotherapy and the number of radiotherapy courses delivered.Main Outcomes and MeasuresGeocoded location of patients receiving external beam radiotherapy (EBRT); median Euclidean distance from the district centroids to the nearest radiotherapy centers; proportion of population living within geographic buffer zones of 100, 150, and 200 km; additional capacity required for optimal utilization; and geographic accessibility after strategic location of a radiotherapy facility in an underserviced region.ResultsA total of 2883 patients underwent EBRT courses in 2020, with an actual RUR of 11%. Based on an optimal RUR of 48%, 11 524 patients had an indication for radiotherapy, indicating that only 23% of patients received treatment. An investment of 23 additional EBRT machines would be required to meet demand. The median Euclidean distance from the district centroids to the nearest radiotherapy facility was 110.6 km (range, 0.62-513.2 km). The proportion of the total population living within a radius of 100, 150 and 200 km of a radiotherapy facility was 47%, 61% and 70%, respectively. A new radiotherapy facility in the northern regional capital would reduce the median of Euclidean distance by 10% to 99.4 km (range, 0.62-267.7 km) and increase proportion of the total population living within a radius of 100, 150 and 200 km to 53%, 69% and 84%, respectively. The greatest benefit was seen in regions in the northern half of Ghana.Conclusions and RelevanceIn this cross-sectional study of geographic accessibility and availability of radiotherapy, Ghana had major national deficits of radiotherapy capacity, with significant geographic disparities among regions. Well-planned infrastructure scale-up that accounts for the population distribution could improve radiotherapy accessibility.

Expanding Access to Computed Tomographic Staging and Three-Dimensional Intensity Modulated Radiotherapy for Cervical Cancer in Ghana

“…However, radiotherapy continues to be unavailable or severely capacity limited in many low-resource countries where CC is endemic and restricted to the use of older treatment techniques that are associated with high recurrence rates and toxicity. 21 , 22 …”

“…However, radiotherapy continues to be unavailable or severely capacity limited in many low-resource countries where CC is endemic and restricted to the use of older treatment techniques that are associated with high recurrence rates and toxicity. 21,22 This report outlines a staged approach to implementing advanced radiotherapy for CC at NCRNM, beginning with investment in a state-of-the-art CT simulator and IMRTcapable treatment machine followed by comprehensive training of a radiation oncologist in gynecological cancer radiation oncology at the PMH and continued collaboration between the NCRNM and PMH interdisciplinary teams afterward. It demonstrates the feasibility of using modern radiotherapy in a low-resource setting and provides early evidence of improved clinical outcomes compared with conventional treatment, specifically fewer acute side effects leading to improved treatment compliance.…”

A Prospective Evaluation of the Quality of Life and Mental Health Implications of Mastectomy Alone on Women in sub-Saharan Africa

“…A recent study of accessibility and availability of radiotherapy in Ghana found geographic disparities in accessibility with less than half of the population living within 100 km from a radiotherapy facility. 24 Given the known effects of radiation on complications, surgical outcomes, and PROs in mastectomy and post-mastectomy breast reconstruction, it is likely that higher rates of radiation in the Ghanaian cohort had negative consequences on quality-of-life experiences of these women. 25 Last, beyond these measured demographic and treatment differences between the cohorts, differences in community, culture, religion, and family dynamics between the populations of women could have had an effect on their experiences with mastectomy.…”

“…Within Ghana, there are currently three radiation facilities in southern Ghana (two in Accra and one in Kumasi) serving the entire population. A recent study of accessibility and availability of radiotherapy in Ghana found geographic disparities in accessibility with less than half of the population living within 100 km from a radiotherapy facility 24 . Given the known effects of radiation on complications, surgical outcomes, and PROs in mastectomy and post-mastectomy breast reconstruction, it is likely that higher rates of radiation in the Ghanaian cohort had negative consequences on quality-of-life experiences of these women 25 .…”