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CANCER MANAGEMENT

CANCER CONTROL 2014 75

radiotherapy. Among them the view that radiotherapy is too

expensive, too complicated, requires specially trained and

hard to find personnel, that other priorities in cancer care

are more important, and that in the longer term newer

treatments will replace radiotherapy and therefore the

investment is not required. These perceptions have limited

the implementation of appropriate radiotherapy resources

in many countries, even in well-resourced ones. There is also

a long-standing perception that cancer is a systemic illness

and the investment in local treatment modalities will not

reduce death rates. The hope for a better systemic therapy,

initially with systemic chemotherapy and now with

molecular targeted agents may detract policy-makers from

investing in radiotherapy. In the meantime, while the

improved systemic therapy is awaited, cancer patients are

dying from the lack of access to proven therapies.

Radiation therapy is also perceived as an expensive

treatment modality. The facts speak otherwise. One

radiation machine can treat thousands of cancer patients

over many years. Even when priced in high-income

countries, radiotherapy is one of the more cost-effective

interventions in cancer.

Another factor is the relatively small manufacturing sector

engaged in producing radiotherapy equipment. Since

industry is fuelled by demand, the lack of investment by

governments in radiotherapy keeps the supply small and the

costs high. This is in contrast to the pharmaceutical industry

where high demand and a large industry have driven the

costs of drugs down in lower income countries. A small

industry does not have the same lobbying power further

limiting the solution to the problem.

Radiotherapy is cost-effective

There is an urgent need to recognize that radiotherapy is one

of more cost-effective treatments for cancer. Planning,

construction and deployment of radiotherapy facilities takes

a long time. Failure to deploy radiation therapy resources

will only exacerbate the burden of cancer and will reinforce

this continuing cancer disparity in the world.

Significant effort has been made to address this deficiency

by the IAEA and the Program of Action for Cancer Therapy

(PACT).

21 However, the speed of progress is far too slow. The

scale of the problem calls for a more urgent response. The

resources of the IAEA, whose mandate does not include

cancer care, are insufficient to solve the problem. In fact, the

mistaken idea that there is a United Nations agency that is

responsible for radiotherapy gives a false sense of security

and comfort. With a lack of investment by governments in

radiotherapy, private facilities offering expensive and mostly

unaffordable radiotherapy have emerged in many countries.

Cancer care is mostly delivered in publically funded systems

and is largely unappealing to private investors. Therefore, an

investment in publically-funded radiotherapy facilities

integrated into comprehensive cancer facilities is long

overdue.

Key messages

‰ Treatment is an important element of cancer control

(prevention and treatment are complementary).

‰ Radiotheraphy (RT) is an indispensible element of a

comprehensive cancer control programme.

‰ The societal benefits of RT depend on its accessibility

(and its quality).

‰ Access to RT is less than optimal in many parts of the

world, both rich and poor.

‰ Making good quality RT more accessible in lower income

countries has the potential to reduce the burden of

cancer dramatically.

‰ Increasing the use of RT in lower income countries

presents unique challenges, but none should be regarded

as insurmountable.

‰ The core elements of a radiation facility are well

understood.

‰ Investments in human resources and education are

required for safety and stability.

‰ A systems-thinking approach is required to address the

challenges of global RT deployment.

‰ Radiotherapy systems are complex and require a high

level of programmatic sophistication for safe operation.

‰ There is a need and opportunity for international

collaboration and harmonization of national guidance

and standards documents. l

Professor Mary K Gospodarowicz is President of the Union for

International Cancer Control and has been active since 1990 in

UICC'S work on cancer staging, currently chairing the TNM

Prognostic Factors Project. She was elected to the Board of

Directors from its inception, serving as a member of the Policy

and Finance Committees, UICC Treasurer, Chair of the

Membership Committee, and finally President.

She is also the Medical Director of the Princess Margaret

Cancer Centre at the University Health Network in Toronto,

Canada and Regional Vice-President of Cancer Care Ontario for

Toronto South. She recently completed a 10 year term as

Professor and Chair of the Department of Radiation Oncology

at the University of Toronto and Chief of the Radiation Medicine

Program at Princess Margaret.

She has edited three editions of Prognostic Factors in Cancer

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