The power of integration: radiotherapy and global palliative care

Abstract

Radiotherapy (RT) is a powerful tool for the palliation of the symptoms of advanced cancer, although access to it is limited or absent in many low- and middle-income countries (LMICs). There are multiple factors contributing to this, including assumptions about the economic feasibility of RT in LMICs, the logical challenges of building capacity to deliver it in those regions, and the lack of political support to drive change of this kind. It is encouraging that the problem of RT access has begun to be included in the global discourse on cancer control and that palliative care and RT have been incorporated into national cancer control plans in some LMICs. Further, RT twinning programs involving high- and low-resource settings have been established to improve knowledge transfer and exchange. However, without large-scale action, the consequences of limited access to RT in LMICs will become dire. The number of new cancer cases around the world is expected to double by 2030, with twice as many deaths occurring in LMICs as in high-income countries (HICs). A sustained and coordinated effort involving research, education, and advocacy is required to engage global institutions, universities, health care providers, policymakers, and private industry in the urgent need to build RT capacity and delivery in LMICs.

Clinical trials in low and middle-income countries — Successes and challenges

“…This is unfortunate, as palliative RT constitutes 30–50% of the workload in Radiation Oncology Departments in HICs and would likely represent an even higher percentage of RT use in LMICs due to increased proportion of patients presenting at advanced stages of disease (Rodin et al, 2016, Lutz and Chow, 2014). Palliative surgery may also have a role in LMICs to relieve suffering resulting from intestinal perforations, tumor blockages, or bleeding (Riesel et al, 2015, Folkert and Roses, 2016).…”

Global palliative radiotherapy: a framework to improve access in resource-constrained settings

“…They also enable peer support and diffusion of innovation such as more effective models of hospice care or morphine use (39). However, analogous, formal radiotherapy networks have not been established, and palliative care programs often are not integrated with curative therapy (5,40).…”

“…In LMICs, where radiotherapy often is underdeveloped or unavailable (5,6,15,16), planning for initiation or scale-up of radiotherapy much be integrated from its inception. Development of radiotherapy capacity should be based on an understanding of radiotherapy as an essential and synergistic part of comprehensive cancer care along with medical and surgical oncology and palliative care and on integration of cancer care with non-communicable disease and HIV/AIDS care and with primary care rather than as a separate programmatic silo.…”

“…In all health systems, radiotherapy is a critical part of both curative treatment and palliation of pain and other symptoms for recurrent or metastatic disease (4,5). An estimated 50% of patients will require access to radiotherapy at some time during their treatment course, and this may be as high as 60-70% in low-income countries (6), where patients tend to present at a late stage (5,7).…”

“…In our previous review, we described how powerful the integration of palliative medicine and palliative radiotherapy could be to improve care for cancer patients globally (5). We included the size of the need for palliative radiotherapy, an analysis of potential barriers and facilitators, and case studies on the emergence of integrated models.…”