Radiotherapy in the Caribbean: a spotlight on the human resource and equipment challenges among CARICOM nations

Abstract

Background There is limited data on access to radiotherapy services for CARICOM nations. Methods This was a descriptive mixed-methods observational study which used data collected via survey from staff working in Radiation Oncology in 14 CARICOM countries. Benchmark recommendations from the International Atomic Energy Agency were compared to existing numbers. The Directory of Radiotherapy Centers, World Bank, and Global Cancer Observatory databases were all accessed to provide information on radiotherapy machines in the region, population statistics, and cancer incidence data respectively. Both population and cancer incidence-based analyses were undertaken to facilitate an exhaustive review. Results Radiotherapy machines were present in only 50% of the countries. Brachytherapy services were performed in only six countries (42.9%). There were a total of 15 external beam machines, 22 radiation oncologists, 22 medical physicists, and 60 radiation therapists across all nations. Utilizing patient-based data, the requirement for machines, radiation oncologists, medical physicists, and radiation therapists was 40, 66, 44, and 106, respectively. Only four (28.6%) countries had sufficient radiation oncologists. Five (35.7%) countries had enough medical physicists and radiation therapists. Utilizing population-based data, the necessary number of machines, radiation oncologists, and medical physicists was 105, 186, and 96 respectively. Only one county (7.1%) had an adequate number of radiation oncologists. The number of medical physicists was sufficient in just three countries (21.4%). There were no International Atomic Energy Agency population guidelines for assessing radiation therapists. A lower economic index was associated with a larger patient/population to machine ratio. Consequentially, Haiti had the most significant challenge with staffing and equipment requirements, when compared to all other countries, regardless of the evaluative criteria. Depending on the mode of assessment, Haiti’s individual needs accounted for 37.5% (patient-based) to 59.0% (population-based) of required machines, 40.1% (patient-based) to 59.7% (population-based) of needed radiation oncologists, 38.6% (patient-based) to 58.3% (population-based) of medical physicists, and 42.5% (patient-based) of radiation therapists. Conclusion There are severe deficiencies in radiotherapy services among CARICOM nations. Regardless of the method of comparative analysis, the current allocation of equipment and staffing scarcely meets 50% of regional requirements.

Prostate Cancer in the Caribbean: A Baseline Assessment of Current Practices and Potential Needs

“…Radiation oncology services are only available in 50% of Caribbean countries and only one country had a sufficient number of radiation oncologists according to a population-based analysis published in 2020. 25 There is less information on the resources available in the rest of the Caribbean countries. Due to the limited number of specialists, primary care physicians are often the point of first contact for patients with suspected prostate cancer providing PSA testing and making decisions on the need for biopsy.…”

Updates in global oncology: Advancements and future directions

“…Radiation oncology is considered the most resource‐intensive component of comprehensive cancer care because of the significant initial investments required for machines, a multifaceted workforce, and recurring maintenance costs 90 . Given the need for these resources, in addition to the financial barrier for patients seeking radiation, there are significant disparities in access to treatment 91,92 . Despite its relative scarcity, models show that expanding access to radiotherapy could lead to survival gains of 2.5% to 6.1% in LMICs 93 .…”

“…90 Given the need for these resources, in addition to the financial barrier for patients seeking radiation, there are significant disparities in access to treatment. 91,92 Despite its relative scarcity, models show that expanding access to radiotherapy could lead to survival gains of 2.5% to 6.1% in LMICs. 93 Additionally, targets for radiation delivery exist.…”