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National Cancer Control Plans (NCCPs) are government policy documents which aim to meet the strategic goals and support the successful implementation of cancer programmes. As radiation oncology is an integral part of a comprehensive cancer program, a call to action of the Global Task Force on Radiotherapy for Cancer Control (GTFRCC) was to include radiotherapy in 80% of NCCPs by 2020. We assessed the proportion of countries which included radiotherapy in their NCCPs and whether there was any correlation with radiotherapy machine availability, country-level income classification and geographic region.

Fourteen items from a previously validated 111-question NCCP quality checklist were selected; these items pertained to radiotherapy and its provision. Data on the inclusion/exclusion of these 14 items in available NCCPs globally were collected by the International Cancer Control Partnership (ICCP). We analysed the proportion of countries globally which included these items in NCCPs and whether there were associations with machine availability, country-level income and/or geographic region. To calculate machine needs, we applied the Collaboration for Cancer Outcomes, Research and Evaluation (CCORE) optimal radiotherapy utilisation model to the GLOBOCAN 2018 incidence data to estimate the demand for radiotherapy and compared this to the Directory of Radiotherapy Centres (DIRAC) data on availability. Analyses were performed using STATA v12.0.

NCCP/Non-Communicable Diseases (NCD) plans were available for 131 countries from 5 regions; 109 of these had available DIRAC data. Across all countries with a NCCP/NCD Plan, 63% (n=83) included any radiotherapy-specific checklist item within the plan. There were 76% of high-income countries that included radiotherapy in their NCCP, 60% of upper-middle-income countries, 66% of low-middle-income countries and 44% of low-income countries (p=0.06). There were 60% of European countries which had a plan to develop or maintain radiotherapy services included in their NCCP, compared to 49% in Africa, 32% in Latin-America and 20% in the Asia-Pacific (p=0.003). European countries were more likely to have a strategy to review new technology documented in their NCCP, at 34% compared to 11% in Africa, 14% in Latin America and 5% in the Asia-Pacific (p=0.05).  We found no correlation between the inclusion of a radiotherapy-specific item and a country’s radiotherapy machine availability (p=0.55).

The inclusion of radiotherapy in NCCPs globally falls below the GTFRCC’s target. European countries were more likely to include radiotherapy-related items in their NCCP than countries from other regions. Strategy for review of new technology was generally poor across all income groups and regions. Machine availability did not correlate with the inclusion of radiotherapy in NCCPs. Local stakeholders, regional organisations and international groups are vital to promote the inclusion of radiotherapy services in future iterations of NCCPs.