TREATMENT
proper understanding of its utilization and a sufficient With LMIC facing an upsurge of cancer incidence rates in
workforce to operate it, while procuring a radiotherapy unit it the coming years and recognizing that the radiotherapy
is important that manufacturers be obliged to provide resources available to fight cancer in LMIC are negligible in
specialized training for local engineers on the use and some areas and non-existent in others, PACT amongst its
maintenance of their product in order to ensure that those several strategic plans has launched an initiative to engage the
operating the machine would use it effectively and safely. manufacturers, users and experts in an open forum called the
Advisory Group on increasing access to Radiotherapy
The role of the IAEA Technology in low- and middle-income countries (AGaRT)46 to
Understanding the radiotherapy needs of its developing find the way forward to expand radiotherapy facilities. AGaRT,
Member States, the IAEA has, for over forty years, worked in deemed “frugal innovation” by Harvard47, was first
over 100 LMIC to deploy robust radiotherapy and nuclear conceptualized in 2009 to bring together radiotherapy
medicine programmes, expending over US$250 million on manufacturers, regional experts and international
cancer-related assistance under its Technical Cooperation organizations from around the world to find affordable,
Programme42, with technical support provided by its Division suitable and sustainable solutions to address the shortfall of
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of Human Health . This has enabled many IAEA Member radiotherapy machines in LMIC.
States to establish safe and effective diagnostic radiology, The rationale behind the AGaRT initiative is to make
radiotherapy and nuclear medicine capacity to provide radiotherapy technology accessible to cancer patients all over
treatment and higher quality diagnosis and care to a portion of the world, regardless of their location or financial situation,
their cancer patients. The IAEA also assists Member States through the development of radiotherapy packages that
with appropriate advice and support for human resources address all of the aforementioned issues with provision of
capacity building. Where resources are available, this helps radiotherapy services46. By addressing issues of accessibility,
Member States to achieve and maintain higher standards of affordability, suitability and sustainability, the IAEA through
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professional practice . AGaRT works to increase the cost-effectiveness and feasibility
With the incidence of cancer on the rise in LMIC, there is an of providing radiotherapy treatment and to assist LMIC to
increased demand for IAEA assistance to introduce or expand tackle their cancer burden in a practical way through
radiotherapy capacity. The resources available to the IAEA are, partnerships with key organizations and the industry. AGaRT’s
however, inadequate to address this huge need. But the aim is to encourage the development of a US$1 million
existing cancer infrastructure in these countries, although far radiotherapy package that integrates all essential radiotherapy
from being able to respond fully to all needs, is potentially the technology with high quality and safety, as well as delivery,
best available launching platform to extend the IAEA’s commissioning, training of maintenance staff and longer term
assistance by encouraging investments in other cancer control support for maintenance. In addition to the reduced costs
components, especially advocacy and public education, cancer associated with such a machine, these radiotherapy packages
registry and surveillance system, prevention, early detection will also utilize uncomplicated, easy to handle technologies that
and screening, and palliative care. Recognizing that strategic are simple to control and maintain, allowing countries without
planning and capacity building for cancer therapy cannot experience in operating radiotherapy units to effortlessly
occur without extensive collaboration with other international transition into radiotherapy use.
key players, in 2004 the IAEA established the Programme of Also, to support the long-term sustainability of radiotherapy
Action for Cancer Therapy (PACT)13,44 in support of the World units, AGaRT encourages the provisions for “whole of life”
Health Assembly’s call to action against cancer. PACT stands support packages from radiotherapy suppliers that will ensure
as the IAEA’s umbrella programme for combating cancer and affordable functionality for the entire life cycle of a unit46. This
builds upon IAEA’s extensive experience in radiation medicine will include evolution in the contracting of radiotherapy units,
knowhow and technology10,43. PACT works closely with WHO, the repatriation and re-supply of radioactive sources, the
its regional offices and other key cancer control stakeholders development of a regional expertise for radiotherapy unit
through the WHO-IAEA Joint Programme on Cancer Control. repairs in low-resource settings and financial planning that
The Joint Programme was established in 2009 to enable might make the initial procurement of equipment more
LMI Member States to improve their cancer control and care expensive, but that has the potential to reduce aggregate costs
capabilities by integrating radiation therapy and nuclear over time.
medicine investments into a comprehensive national cancer Recalling the extreme shortage of resources and staff in
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control programme . LMIC facing ever increasing demand for treatment by a
92 CANCER CONTROL 2013