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Jamal Saleh Khader

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    ES09 - How I Do It - Real World Issues in the Diagnosis and Treatment of Metastatic NSCLC (ID 12)

    • Event: WCLC 2019
    • Type: Educational Session
    • Track: Treatment in the Real World - Support, Survivorship, Systems Research
    • Presentations: 1
    • Now Available
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      ES09.05 - Limitations in the Availability of Radiotherapy (Now Available) (ID 3203)

      13:30 - 15:00  |  Presenting Author(s): Jamal Saleh Khader

      • Abstract
      • Presentation
      • Slides


      Limitations in the Availability of Radiotherapy


      The annual global incidence of cancer, according to Globocan 2018 report is 18 million new cancer cases, and the number is projected to rise in 2035 to 25 million cases (13 million deaths), with 70% occurring in low- and middle -income countries (LMICs), where there is a severe shortfall in the availability of radiotherapy (1). Radiotherapy is an essential component of overall curative and palliative cancer care. It is estimated that about half of cancer patients would benefit from radiotherapy for treatment of localized disease, local control, and palliation (2). Yet, this crucial component of the response to cancer has been largely absent from global health discourse, and has received limited domestic and international funding. As a result, there is a worldwide shortfall of radiotherapy services; with more than 90% of the population in low-income countries, lacking access to radiotherapy(2). The growing burden of cancer will place increased demand on the already-scarce radiotherapy services worldwide. A 2015 report by the Global Task Force on Radiotherapy for Cancer Control estimated that by 2035 at least 5000 additional megavolt treatment machines would be needed to meet LMIC demands, together with about 30 000 radiation oncologists, 22 000 medical physicists and 80 000 radiation therapy technologists(3).

      Many of the challenges in delivering radiotherapy in LMICs that were identified including: (a) a shortage of good-quality radiotherapy equipment capable of both simple and more complex radiotherapy treatment delivery, (b) the challenge of servicing the linacs, both for preventative maintenance and upon equipment breakdown and (c) the chronic shortage of adequately trained personnel(3). In LMICs, the costs of equipment, building and salaries are 81, 9 and 10% of the total cost of the facility, respectively, compared with 30, 6 and 64% in high-income countries. Some of the challenges facing LMICs are also related radiofrequency power systems, linac beam production and control, durable and sustainable power supplies, computer applications in radiation therapy & linac safety and operability(4). Investment in radiotherapy is crucial and an imperative in low-income and middle-income countries, if unnecessary cancer deaths and suffering are to be avoided. Investment in radiotherapy is timely for many reasons, including evidence from The Lancet Commission on Investing in Health (5) showing the benefits of investing in health to achieve convergence in health outcomes between low-income countries and upper-middle-income countries, the momentum for investing in low-income and middle-income countries to expand surgery,(6) and the UN resolution on sustainable development, which recognises that “universal health coverage is a key instrument to enhancing health, social cohesion and sustainable human and economic development”.(7)


      It is a call for action to enhance population-based cancer control plans, expansion of access to radiotherapy, human resources for radiotherapy, sustainable financing to expand access to radiotherapy and align radiotherapy access with universal health coverage.


      1.Freddie B et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.

      CA CANCER J CLIN 2018;68:394–424

      2.Barton MB et al. Estimating the demand for radiotherapy from the evidence: a review of changes from 2003 to 2012. Radiother Oncol 2014; 112: 140–44.

      3.Atun R, et al. Expanding global access to radiotherapy. Lancet Oncol 2015;16(10):1153e1186

      4. Dosanjh M et al. Developing Innovative,Robust and Affordable Medical Linear

      Accelerators for Challenging Environments, Clin Oncol , 2019 Jun; 31(6):352-355

      5.Jamison DT et al. Global health 2035: A world converging within a generation.

      Lancet 2013; 382: 1898–955.

      6. Meara JG et al. Global Surgery 2030: evidence and solutions for achieving health,

      welfare, and economic development. Lancet 2015; 386: 569–624.

      7. UN. Sustainable development, the Future We Want, UN General Assembly

      Resolution, A/66/L.56, para 138–141.

      (accessed July 5, 2015).

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