An estimated 9.6 million deaths in 2018 were attributed to cancer, making it the second leading cause of death worldwide. Left unchecked, the problem will increase to an estimated 29.5 million new cases and 16.3 million deaths occurring worldwide in 2040.
Radiotherapy is a critical component of effective cancer services worldwide and a very cost-effective treatment. 50% of cancer patients need radiotherapy, however, such access is still limited, especially in low- and middle-income countries (LMIC). Many LMIC countries in spite of an increasing burden of cancer lack infrastructure, human resources, and access to various components of cancer management. For example, the current median density of radiotherapy machines per million population are 5.1 in high-income countries (HICs) and 0 in low-income countries. This is a tragedy on many fronts. In addition, the Lancet Oncology Commission report on radiotherapy concluded that the potential to save nearly one million lives per year by 2035 through optimal access to radiotherapy would lead to a net macroeconomic benefit of up to $365 billion in US dollars (USD) over the 20-year scale-up period. There are many factors affecting access to RT. For example, around 5% of the national health expenditure goes towards cancer in general, and radiotherapy expenditure per se constitutes only around 5% of the total cancer cost. Furthermore, socioeconomic status of a country often correlates with the available resources, making global access to radiotherapy very heterogeneous. In addition, challenges in human resource availability are an issue. Even while trained professionals are key for the sustainable growth of radiotherapy. The number of professionals is not the only factor to consider, but more importantly, the quality of professional training must be considered. As for equipment, a significant upfront investment is required for setting up a radiotherapy program. Even then, operational and maintenance can still be challenging for LMICs. This affects sustainability of the programs and the ability to achieve growth in radiotherapy access on a national level. Innovative solutions are essential. While more resources are definitely needed, it is as important that we determine best practices to enhance efficiencies. Factors leading to successful implementation of educational, research and clinical activities must be assessed. Innovation in education through microlearning, use of IT based technologies and multi-media are needed. Telecommunication, automation, remote support, virtual collaboration can help. Opportunities to improve efficiencies through innovation are needed such as instituting virtual reality training before hands on in-person training, to steepen the learning curves. Acceleration of the education and training of new radiation oncology professionals must keep up with the rate of increase of cancer incidence. Research is a key pillar for the long-term improvement of cancer control. International multi-institutional global research allows diverse participation and is results are more readily applicable to LMICs. Research can also identify the complexities in health systems and costing of interventions. Finally, efficiencies such as the greater use of hypofractionation and the assessment of the effectiveness of educational and other interventions is also needed. Collaboration can enhance the rate of progress. Global initiatives in breast cancer, cervical cancer and pediatric cancers have brought together multiple UN organizations, NGOs, academic institutions and others to work together towards a common goal. The IAEA’s ambitious Rays of hope Global initiative launched at the 2022 African Union heads of State meeting by IAEA DG Grossi and incoming chair of the African Union and Senegalese President Sall includes an initial assessment of affordability and cost-benefit of service expansion in radiotherapy and diagnostic imaging as well as support for equipment, training, research, nuclear safety infrastructure, quality improvement, innovation and education. Direct technical expertise and support of regional Anchor centers will be provided as well.