Strategies to Maximize Available Resources With Minimum Cost Escalation for Improving Radiation Therapy Accessibility in the Post–Coronavirus Disease 2019 Era: An Analysis for Asia

Abstract

Purpose There is widespread accord among economists that the COVID-19 pandemic will have a severe negative impact on the global economy. Establishing new radiotherapy (RT) infrastructure may be significantly compromised in the post COVID-19 era. Alternative strategies are needed to improve the existing RT accessibility without significant cost escalation. The outcomes of these approaches on the RT availability has been examined for Asia. Methods and Materials The details of RT infrastructures in 2020 for 51 countries in Asia were obtained from the Directory of Radiotherapy Centers of the International Atomic Energy Agency (IAEA). Using the IAEA guidelines, the %RT accessibility and the additional requirements of teletherapy (TRT) units were computed for these countries. To maximize the utilization of the existing RT facilities, five options were evaluated, namely, hypofractionation RT (HFRT) alone, with/without 25% or 50% additional working hours. The impact of these strategies on the %RT access and additional TRT unit requirements to achieve 100% RT access were estimated. Results 4617 TRT units are available in 46 countries. The mean %RT accessibility is 62.4% in 43 countries (TRT units =4491) where the information on cancer incidence was also available and these would need an additional 6474 TRT units for achieving 100% RT accessibility. By adopting HFRT alone, increasing the working hours by 25% alone, 25% with HFRT, 50% alone and 50% with HFRT; the %RT access could improve to 74.9%, 78%, 90.5%, 93.7% and 106.1% respectively. Correspondingly, the need for additional TRT units would progressively decrease to 4646, 4284, 3073, 2820 and 1958 units. Conclusion The economic slowdown in the post Covid-19 period could severely impend establishment of new RT facilities. Thus, maximal utilization of the available RT infrastructure with minimum additional costs could be possible by adopting HFRT with or without increased working hours to improve the RT coverage.

Benefits of Adopting Hypofractionated Radiotherapy as a Standard of Care in Low-and Middle-Income Countries

“…Access to radiotherapy in many regions is often limited because of an insufficient number of radiation oncology clinics, trained personnel, and treatment machines. 2 , 4 , 27 , 28 The consequences of limited availability of radiotherapy are best illustrated by a report from Brazil in 2016 which found that limited access to radiotherapy was estimated to result in more than 5,000 deaths among patients with prostate, breast, colorectal, lung, and cervical cancer. 29 In a 2020 analysis of 46 countries, it was estimated that radiotherapy is only accessible to approximately 62% of the patients who could benefit from it and that an additional 5,987 treatment machines would be needed in LMICs to fully meet the radiotherapy demand.…”

Global challenges of radiotherapy for the treatment of locally advanced cervical cancer

“…30 Datta et al recently identified a combination of hypofractionated radiotherapy ± longer working hours to improve overall radiotherapy coverage with existing facilities in 43 countries in Asia, where economic development has been significantly impacted by the pandemic. 31 Shorter brachytherapy regimens may also help patient compliance, as there is evidence to suggest that significant psychological distress is associated with current recommended regimens. 32 Two ongoing phase II trials in Mexico (NCT04070976) and Canada (HEROICC-Trial (NCT04583254)) are evaluating the efficacy and safety of hypofractionated radiotherapy doses in concurrent chemoradiotherapy for locally advanced cervical cancer.…”

“…During the coronavirus disease 2019 (COVID-19) pandemic, hypofractionated radiotherapy regimens have been used with some success 30. Datta et al recently identified a combination of hypofractionated radiotherapy ± longer working hours to improve overall radiotherapy coverage with existing facilities in 43 countries in Asia, where economic development has been significantly impacted by the pandemic 31. Shorter brachytherapy regimens may also help patient compliance, as there is evidence to suggest that significant psychological distress is associated with current recommended regimens 32.…”

Implementation of 3D conformal radiotherapy technology at the National Cancer Centre Mongolia: A successful Asia‐Pacific collaborative initiative

“…The recently established IAEA ASTRONET Virtual Tumour Board 19 provides further opportunity for international networking and knowledge transfer. This mode of virtual delivery is particularly needed in the setting of the COVID‐19 pandemic 20 . Finally, mentorship in the development of research initiatives and infrastructure development 21 remains an area of ongoing interest.…”

“…This mode of virtual delivery is particularly needed in the setting of the COVID-19 pandemic. 20 Finally, mentorship in the development of research initiatives and infrastructure development 21 remains an area of ongoing interest.…”