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
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
‰ 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
‰ Increasing the use of RT in lower income countries
presents unique challenges, but none should be regarded
‰ The core elements of a radiation facility are well
‰ 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