Page 0093

TREATMENT

Moreover, one of the country’s three machines now radiotherapy facilities in most LMIC. Although some

requires a source replacement, which, priced at US$150,000, international programmes, such as those supported by the IAEA

may take some time to acquire, leaving Albania’s nearly 8,000 or ESTRO, offer fellowships for education and training, as well as

cancer patients to receive treatment on only two machines38. continuous professional development, for cancer professionals,

Yet, there remain more issues that can arise in relation to the the number they can train is far below demand.

technical support needed to run a radiotherapy unit, and that When looking solely at cancer professionals, it is estimated

is to do with the available workforce of clinicians, nurses and that in Africa alone there will be a deficit of 3,000 cancer

support staff and their education and training. The number of health professionals over the next 10 years40. Education and

staff actually involved in the operation of a radiotherapy training of oncology professionals is an urgent issue requiring

service can vary between centres, often depending on the new and innovative approaches, especially utilization of e-

number of available qualified professionals. For a basic learning and online learning41.

radiotherapy centre treating up to 1,000 patients a year with Considering that some of the positions required to establish

two megavoltage teletherapy machines, a high-dose rate a radiotherapy service require a university degree,

brachytherapy unit and other standard equipment such as an postgraduate studies and at least two years of clinical training,

imaging device (a conventional or computed tomography staffing radiotherapy centres will continue to be a challenge in

simulator), immobilisation devices, shielding devices, a LMIC19. In this context, there is an on-going discussion on the

treatment planning computer system and physical dosimetry possibility of adjusting the number of professionals managing a

tools; the IAEA recommends a staffing of around 20 (4–5 megavoltage machine if a less complex linac requiring less

radiation oncologists, 3–4 medical physicists, 7 radiation dosimetry and less frequent calibration were to be developed.

therapy technologists, 3 radiotherapy nurses, and a This issue merits a careful expert review. The IAEA guidelines

11,19

maintenance engineer) . In more detail, this team consists of clearly specify that the clinical use of ionizing radiation is a

a radiation oncologist-in-chief, one staff radiation oncologist complex process and must involve highly trained personnel in a

per 200–250 patients, one radiation physicist for every 400 variety of interrelated activities as described above.

patients, one dosimetrist or physics assistant per 300 patients, However, the IAEA minimum personnel requirements are

one mould room technician per 600 patients, four RTTs adopted from the experience in more developed countries and

(radiation therapy technologists) per megavoltage unit the recommendations of ESTRO and EFOMP. In 2008, a panel

treating up to 50 patients per day, 2 RTT-simulation for every of IAEA experts agreed that the personnel requirements may

500 patients simulated annually, and RTT-brachytherapy as have to be adjusted for LMIC, where the increased ratio of

needed, as well as a nurse for every 300 patients, a social palliative to radical cases and simpler and shorter treatment

worker, a dietician, a physiotherapist and a maintenance protocols reduce the duration of professional involvement

19

engineer or electronics technician . The staff requirements with each patient11.

will increase if special or advanced techniques such as three The problem is exacerbated further in LMIC, where a lack of

dimensional treatment planning or conformal radiotherapy resources and the prospect of better pay drive trained

are employed. To ensure sustainability, it is also essential that professionals to work in high-income countries. The loss of

centres gradually develop their capacity for local training of trained medical professionals in specialized areas such as

some of their own staff like technologists and provide radiotherapy is an increasing problem, particularly in Africa

continuous education programmes. and parts of Asia. This bears directly on the quality of

Unfortunately, meeting the staff requirements for a radiotherapy delivered in LMIC. In many cases, the cancer care

radiotherapy clinic is difficult as the world faces a shortfall of 4.3 professionals who remain in the country have limited access

million trained health workers and 57 countries are currently for practice on radiotherapy and other radiation medicine

experiencing a health care workforce crisis, leaving health equipment due to a lack of adequate facilities (and time, as

systems everywhere with insufficient staff available to meet the most often they work in more than one normal shift), and may

39

needs of their patients . As stated earlier, many cancer clinics require additional training to apply new techniques or to

across the world are short of specialists, particularly medical operate newly acquired technologies. Additionally, workforce

physicists and oncology nurses. This is the case for most of strength may require that a small group of professionals take

Africa, and a significant number of countries in Asia, Latin on a larger-than-recommended role in the operation of

America, and even Eastern Europe considering the number of machinery, requiring further specialized training to operate a

new patients and the required staffing. Lack of well trained staff radiotherapy unit efficiently and effectively.

results in inappropriate or underutilization of the scarce Finally, as procuring a machine is fruitless without the

CANCER CONTROL 2013 91

Index

  1. CANCER CONTROL 2013
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