Abstract
Objectives: The cancer burden in low- and middle-income countries (LMIC) is substantial. The purpose of this study was to identify and describe country and region-specific patterns of radiotherapy (RT) facilities in LMIC.Methods: A systematic review of the literature was undertaken. A search strategy was developed to include articles on radiation capacity in LMIC from the following databases: PubMed, Embase, CINAHL Plus, Global Health, and the Latin American and Caribbean System on Health Sciences Information. Searches included all literature up to April 2013.Results: A total of 49 articles were included in the review. Studies reviewed were divided into one of four regions: Africa, Asia, Eastern Europe, and South America. The African continent has the least amount of resources for RT. Furthermore, a wide disparity exists, as 60% of all machines on the continent are concentrated in Egypt and South Africa while 29 countries in Africa are still lacking any RT resource. A significant heterogeneity also exists across Southeast Asia despite a threefold increase in megavoltage teletherapy machines from 1976 to 1999, which corresponds with a rise in economic status. In LMIC of the Americas, only Uruguay met the International Atomic Energy Agency recommendations of 4 MV/million population, whereas Bolivia and Venezuela had the most radiation oncologists (>1 per 1000 new cancer cases). The main concern with the review of RT resources in Eastern Europe was the lack of data.Conclusion: There is a dearth of publications on RT therapy infrastructure in LMIC. However, based on limited published data, availability of RT resources reflects the countries’ economic status. The challenges to delivering radiation in the discussed regions are multidimensional and include lack of physical resources, lack of human personnel, and lack of data. Furthermore, access to existing RT and affordability of care remains a large problem.
Highlights
As populations’ age and infectious disease control extends lifespan, cancer and other non-communicable diseases are becoming increasingly significant burdens of mortality in low- and middleincome countries (LMIC) [1]
A significant heterogeneity exists across Southeast Asia despite a threefold increase in megavoltage teletherapy machines from 1976 to 1999, which corresponds with a rise in economic status
The International Atomic Energy Agency (IAEA), has organized the Directory of Radiotherapy Centres (DIRAC), which acts as a central record and quantification of international radiotherapy (RT) capacity
Summary
As populations’ age and infectious disease control extends lifespan, cancer and other non-communicable diseases are becoming increasingly significant burdens of mortality in low- and middleincome countries (LMIC) [1]. Over 70% of cancer cases will be diagnosed in LMIC by 2030 [2]. Most developing countries do not have the resources or infrastructure to prevent, diagnose, or treat this growing burden of cancer [2]. Existing data represents only a fraction of the true burden of cancer, with our best estimates being estimates at best. Apart from DIRAC, few reports exist that describe the capacity requirements necessary to deliver RT. This capacity includes country-specific infrastructure, equipment, personnel training, quality assurance, and challenges surrounding RT facilities.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
