Access to Radiotherapy in Ghana: A Geospatial Analysis

Abstract

Radiotherapy (RT) is a crucial component of comprehensive cancer care, but there are large global gaps in access. Within Ghana, a West African country with a population of 31 million, there are only 3 RT centers with 5 external-beam (EBRT) and 2 high-dose rate (HDR) brachytherapy (BT) machines located in 2 cities in the south. This study describes the gaps in RT capacity and geographic accessibility.A retrospective review of all RT centers in Ghana was done to determine the number of RT courses, EBRT fractions, and BT insertions for cervical cancer delivered annually between 2018-2020. Additional RT capacity required for optimal utilization was estimated from GLOBOCAN 2020 and the Collaboration for Cancer Outcomes Research and Evaluation radiotherapy utilization rate (RUR) model. A time-driven activity-based model was used to estimate the number of machines and centers required to deliver this capacity. Geospatial modeling was used to calculate current travel distances to access RT, and how access would improve with new RT centers strategically located throughout the country.In 2020, Ghana delivered 1,794 RT courses and 34,624 EBRT fractions for all cancers, and performed 497 HDR BT insertions for cervical cancer (2nd most common cancer in women in Ghana). Based on a RUR of 48%, an additional 9,730 RT courses, 188,948 EBRT fractions and 4,538 HDR BT insertions are required. With standard operational parameters, this translates to 5 additional RT centers, each with 4 EBRT units and 1 HDR BT afterloader. Based on current capacity and center locations, patients have a median one-way travel distance from their regional capital to the nearest RT center of 157 km, with 54% of patients traveling less than 100 km, 15% traveling 100-150 km, 9% traveling 150-200 km, and 22% traveling > 200 km. The North East, Upper East, and Upper West regions have the longest travel distances of 424 km, 533 km, and 439 km, respectively. Establishing a new RT center in Tamale in northern Ghana would decrease median one-way travel distance from the regional capitals to the nearest center to 145.5 km, and the proportion of the population with a travel distance > 200 km to 4%. Optimizing the location of other new centers is needed to further reduce travel distances.Ghana has a major national deficit of RT capacity, with significant geographic disparities among regions. Well-planned infrastructure scale-up that accounts for the population distribution can improve RT accessibility.