Current and projected gaps in the availability of radiotherapy in the Asia-Pacific region: a country income-group analysis

Abu Awwad D 1 , Shafiq J 2 , Delaney GP 2 , Anacak Y 3 , Bray F 4 , Flores JA 5 Show all authors , Gondhowiardjo S 6 , Minjgee M 7 , Permata TBM 8 , Pineda JC 9 , Yusak S 10 , Zubizarreta E 11 , Yap ML 12

Affiliations 

  • 1 Faculty of Medicine and Health, University of Sydney, Sydney, Australia
  • 2 Collaboration for Cancer Outcomes, Research and Evaluation, Liverpool Hospital, Ingham Institute, University of New South Wales, Liverpool, NSW, Australia
  • 3 Department of Radiation Oncology, Faculty of Medicine, Ege University, Izmir, Turkey
  • 4 Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
  • 5 Jose R Reyes Memorial Medical Center, Manila, Philippines; AC Sacred Heart Medical Center, Pampanga, Philippines
  • 6 Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia; Department of Radiation Oncology, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia; Indonesian Radiation Oncology Society, South Jakarta, Indonesia
  • 7 National Cancer Center, Ulaanbaatar, Mongolia
  • 8 Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia; Department of Radiation Oncology, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
  • 9 AC Sacred Heart Medical Center, Pampanga, Philippines
  • 10 National Cancer Institute, Putrajaya, Malaysia
  • 11 International Atomic Energy Agency, Vienna International Centre, Vienna, Austria
  • 12 Collaboration for Cancer Outcomes, Research and Evaluation, Liverpool Hospital, Ingham Institute, University of New South Wales, Liverpool, NSW, Australia; The George Institute for Global Health, University of New South Wales, Barangaroo, NSW, Australia; Macarthur Cancer Therapy Centres, Western Sydney University, Campbelltown, NSW, Australia. Electronic address: meiling.yap@health.nsw.gov.au
Lancet Oncol, 2024 Feb;25(2):225-234.
PMID: 38301690 DOI: 10.1016/S1470-2045(23)00619-8

Abstract

BACKGROUND: Cancer incidence and mortality is increasing rapidly worldwide, with a higher cancer burden observed in the Asia-Pacific region than in other regions. To date, evidence-based modelling of radiotherapy demand has been based on stage data from high-income countries (HIC) that do not account for the later stage at presentation seen in many low-income and middle-income countries (LMICs). We aimed to estimate the current and projected demand and supply in megavoltage radiotherapy machines in the Asia-Pacific region, using a national income-group adjusted model.

METHODS: Novel LMIC radiotherapy demand and outcome models were created by adjusting previously developed models that used HIC cancer staging data. These models were applied to the cancer case mix (ie, the incidence of each different cancer) in each LMIC in the Asia-Pacific region to estimate the current and projected optimal radiotherapy utilisation rate (ie, the proportion of cancer cases that would require radiotherapy on the basis of guideline recommendations), and to estimate the number of megavoltage machines needed in each country to meet this demand. Information on the number of megavoltage machines available in each country was retrieved from the Directory of Radiotherapy Centres. Gaps were determined by comparing the projected number of megavoltage machines needed with the number of machines available in each region. Megavoltage machine numbers, local control, and overall survival benefits were compared with previous data from 2012 and projected data for 2040.

FINDINGS: 57 countries within the Asia-Pacific region were included in the analysis with 9·48 million new cases of cancer in 2020, an increase of 2·66 million from 2012. Local control was 7·42% and overall survival was 3·05%. Across the Asia-Pacific overall, the current optimal radiotherapy utilisation rate is 49·10%, which means that 4·66 million people will need radiotherapy in 2020, an increase of 1·38 million (42%) from 2012. The number of megavoltage machines increased by 1261 (31%) between 2012 and 2020, but the demand for these machines increased by 3584 (42%). The Asia-Pacific region only has 43·9% of the megavoltage machines needed to meet demand, ranging from 9·9-40·5% in LMICs compared with 67·9% in HICs. 12 000 additional megavoltage machines will be needed to meet the projected demand for 2040.

INTERPRETATION: The difference between supply and demand with regard to megavoltage machine availability has continued to widen in LMICs over the past decade and is projected to worsen by 2040. The data from this study can be used to provide evidence for the need to incorporate radiotherapy in national cancer control plans and to inform governments and policy makers within the Asia-Pacific region regarding the urgent need for investment in this sector.

FUNDING: The Regional Cooperative Agreement for Research, Development and Training Related to Nuclear Science and Technology for Asia and the Pacific (RCA) Regional Office (RCARP03).

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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