Radiotherapy service need in the Pacific Island countries

Abstract

Background: Pacific Island Countries and Territories (PICTs) have experienced an increase in cancer burden in the recent years. There is need for major investments in the cancer treatment facilities including radiotherapy (RT).Aims: This study aimed to provide a quantitative estimation of the effect of establishing new RT facilities on patient access through Geographic Information System (GIS) modelling of population density and service availability to assess the best location for a new RT centre when there are multiple competing locations. Methods: Methods involved cancer epidemiological data collection and assessing RT demand (proportion needing RT) in 2040, assessment of current RT facilities meeting the demand, GIS-based assessment of minimal travel distance in relation to RT demand and scenario-based location planning with adoption of the principles of efficiency, availability and equity for establishment of suitability of new RT facilities. Results: In 2040, three highest new cancer case projections are for Papua New Guinea (PNG) (22662), Fiji ( 2058) and New Caledonia (2037). Twenty-nine megavoltage machines (MVMs) are needed to meet adequate RT demand with three existing in New Caledonia, Guam and French Polynesia meeting 2-6% demand. PNG with highest RT demand of 68% and Fiji with second highest (6%) demand are found as the choice venues for maximum accessibility of cancer population within the PICTs. Conclusion:The travel distance-based GIS modelling estimation of establishment of new RT facilities will provide useful information for planning of RT services in the PICTS with improved patient outcome.

Value of Geographical Information Systems in Analyzing Geographic Accessibility to Inform Radiotherapy Planning: A Systematic Review

“…Twenty-four studies used GIS to describe geographic accessibility to RT (Table 3 ), measured via travel distance 5 , 34 - 49 and travel time 3 , 4 , 20 , 22 , 35 , 36 , 45 , 48 , 50 - 55 to nearest RT centers. These were calculated on the basis of travel by road, 3 , 4 , 20 , 22 , 34 - 36 , 38 , 40 , 42 - 57 air, 36 , 58 or by Euclidean distance. 5 , 37 , 39 , 41 Several studies calculated geographic catchment areas and defined vulnerable population groups to describe access.…”

“… 39 In Italy, adding RT centers significantly reduced the proportion of patients with breast cancer who omit postoperative RT. 35 Shafiq et al 58 showed that establishing 26 new megavoltage machines in areas of highest need in Pacific Island Countries and Territories on the basis of 2040 modeled cancer incidence met 90% of the RT demands, compared with 14% with current resources. Aggarwal et al 71 found that 21% of patients with prostate cancer traveled beyond their nearest RT center for treatment in the United Kingdom.…”

“…Several studies used GIS to calculate changes in travel times and distances with the addition of RT centers in areas of need. Mean travel times and distances reduced, 36 , 70 , 71 leading to improved outcomes, including increased RUR, 51 , 58 , 69 reduced RT omission, 5 , 35 , 56 and reduced mastectomy rates. 39 Many standalone components, such as single machine units, were found to have similar standards of care as larger or central departments.…”

“…Notably, 18 studies used GIS to describe disparities in geographic accessibility to RT. 3,5,20,34,36,37,[39][40][41][42][43][44]48,56,58 Four studies 3,38,43,48 found that rural-residing patients had to cover larger road distances to the nearest RT center, compared with urban-residing patients, and five studies reported that Indigenous or underserved populations faced inequitable RT access. 36,37,41,56,58 Yao et al 56 and Shafiq et al 58 found that, relative to surrounding areas, RT facilities in areas with vulnerable were inadequate.…”

A collaborative approach to meeting oncology challenges in island communities in the Asia‐Pacific region

“…Local healthcare professionals need to be trained and provided with continuing professional support and education to ensure sustainability of services, which can often be threatened by the migration of skilled staff to wealthier countries. Provision of radiation treatment, in particular, is affected by all these challenges and none of the island communities described has a functioning radiotherapy service, although recent modeling 17 suggests that 29 megavoltage machines are needed to meet current demand in PICTs.…”