Global radiotherapy challenge: turning data into action
Authors: Danielle Rodin, May Abdel-Wahab, Yolande Lievens
Journal: The Lancet Global Health (2018)

The global cancer burden is continuously increasing. 15 million new cancer cases and nearly 9 million deaths from cancer occurred in 2016, representing an 18% increase in the past decade.1GBD 2016 Causes of Death CollaboratorsGlobal, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease Study 2016.Lancet. 2017; 390: 1151-1210Summary Full Text Full Text PDF PubMed Scopus (2930) Google Scholar Within the next 20 years, those numbers are forecast to increase to 24 million new cases and 14·5 million deaths worldwide.2Ferlay J Soerjomataram I Erwick M et al.GLOBOCAN 2012 v1.0. Cancer incidence and mortality worldwide: IARC cancer base n 11. International Agency for Research on Cancer, Lyon2013Google Scholar To reverse this trend, a long-term vision and a collaborative multidisciplinary effort in cancer prevention, early diagnosis, multidisciplinary treatment schemes, and policy reform are needed. Although prevention has typically dominated the global health discourse, large gaps in access to cancer care and to optimal oncological therapies persist, especially in low-income and middle-income countries (LMICs), as demonstrated in two Lancet Oncology Commission reports about cancer surgery and radiotherapy.3Sullivan R Alatise OI Anderson BO et al.Global cancer surgery: delivering safe, affordable, and timely cancer surgery.Lancet Oncol. 2015; 16: 1193-1224Summary Full Text Full Text PDF PubMed Scopus (339) Google Scholar, 4Atun R Jaffray DA Barton MB et al.Expanding global access to radiotherapy.Lancet Oncol. 2015; 16: 1153-1186Summary Full Text Full Text PDF PubMed Scopus (516) Google Scholar Radiotherapy is a central component of the comprehensive management of most cancers worldwide and is essential for curative treatment and palliation of the symptoms of advanced cancer. However, the disparities in its access are one of the largest technology gaps in health care today, in which many patients in the world have no opportunities to access radiotherapy treatment in their countries. This enormous inequity was created and perpetuated by a lack of awareness about the global need for radiotherapy and myths about its feasibility and affordability. From 2013 to 2015, more than 100 experts in oncology, global health, and economics were joined together by the Union for International Cancer Control (UICC) to form the Global Task Force on Radiotherapy for Cancer Control (GTFRCC). The GTFRCC was created to quantify the gap in access to radiotherapy and the cost of closing this gap and to develop an investment case for radiotherapy to support its scale-up and deployment in LMICs. Their findings showed the potential to save nearly 1 million lives per year by 2035 through optimal access to radiotherapy, with a net macroeconomic benefit of up to US$365 billion over the 20-year scale-up period. The GTFRCC's report ended with a number of calls to action that included measurable targets for expansion of human resources, equipment, and national cancer control planning. The investment framework provided a solid evidence base from which the global health community could advocate to meet these targets. Translating this evidence into practice, however, necessitates strong global engagement in the form of grassroots advocacy and community activism and the coordinated efforts of professional groups and non-governmental organisations. The International Atomic Energy Agency (IAEA) has been engaged in radiotherapy programme development for many years by providing technical support to new radiotherapy facilities and facilities undergoing upgrading, by strengthening quality assurance and safety precautions, and by offering in-person training and fellowships.5Abdel-Wahab M Rosenblatt E Homberg O Meghzifene A Safety in radiation oncology-the role of International initiatives by IAEA.J Am Coll Radiol. 2011; 8: 789-794Summary Full Text Full Text PDF PubMed Scopus (27) Google Scholar Other organisations are now engaged in this work, including UICC, the International Cancer Experts Corps, Radiating Hope, and GlobalRT. At the clinical level, remote tumour boards through ChartRounds and institutional partnerships have also developed to support radiotherapy programme development. There is also a continued need for knowledge generation to guide policy making. In partnership with the original core collaborators of GTFRCC and building on its prior experience at the European level,6Lievens Y Grau C Health economics in radiation oncology: introducing the ESTRO-HERO project.Radiother Oncol. 2012; 103: 109-112Summary Full Text Full Text PDF PubMed Scopus (65) Google Scholar, 7Borras JM Lievens Y Dunscombe P et al.The optimal utilization proportion of external beam radiotherapy in European countries: an ESTRO-HERO analysis.Radiother Oncol. 2015; 116: 38-44Summary Full Text Full Text PDF PubMed Scopus (112) Google Scholar the European Society for Radiotherapy and Oncology launched the Global Impact of Radiotherapy in Oncology (GIRO) project. GIRO aims to enhance access to radiotherapy worldwide by applying a data-driven approach, whereby knowledge is translated into action and methodological expertise is extended into the development of practical applications.8Lievens Y Gospodarowicz M Grover S et al.GIRO steering and advisory committeesGlobal impact of radiotherapy in oncology: saving one million lives by 2035.Radiother Oncol. 2017; 125: 175-177Summary Full Text Full Text PDF PubMed Scopus (23) Google Scholar GIRO will operate in strong collaboration with the IAEA, which not only supports research programmes on radiotherapy and medical physics in LMICs but also has a strong focus on real-life data collection.9Abdel-Wahab M Fidarova E Polo A Global access to radiotherapy in low and middle-income countries.Clin Oncol. 2017; 29: 99-104Summary Full Text Full Text PDF PubMed Scopus (34) Google Scholar, 10Abdel-Wahab M Zubizarreta E Polo A Meghzifene A Improving quality and access to radiation therapy—an IAEA perspective.Semin Radiat Oncol. 2017; 27: 109-117Summary Full Text Full Text PDF PubMed Scopus (38) Google Scholar For example, the web-based DIRAC directory, which contains information on worldwide availability of radiotherapy resources, forms the ideal basis to assess global radiotherapy needs and costs and, as such, has helped facilitate the GTFRCC's work. This approach is anticipated to empower radiotherapy professionals and health-care policy makers to make the right decisions in individual radiotherapy investment cases and leverage radiotherapy support and expansion by the national radiotherapy societies in their respective countries. It is our firm belief that only when data and actions are aligned and theoretically achievable outcomes prompt implementation, will radiation oncology become effective at the global level and the ultimate goal of saving 1 million lives by 2035 become achievable. We declare no competing interests.