Assessment of Radiation Therapy Resources in the Dominican Republic

Abstract

The Dominican Republic (DR) is an upper-middle-income country that has taken several strides to address cancer care at the national level. In 2007, a national healthcare plan known as the Seguro Familiar Salud (SFS) was established. Presently, the SFS provides coverage to 65% of the DR population and substantially covers radiotherapy center and machine maintenance costs; in effect, there has been a drastic expansion of radiotherapy services since 2010. We sought to review the radiotherapy resources currently in the DR and assess the impact of these resources within the Caribbean. We queried the Directory of Radiotherapy Centres (DIRAC) to obtain information on the radiotherapy resources in the Caribbean. Groupe Européen de Curiethérapie-European Society for Radiotherapy and Oncology (GEC-ESTRO) and International Atomic Energy Agency (IAEA) recommendations in conjunction with 2012 GLOBOCAN cancer incidence data were employed to assess the radiotherapy resources in the DR and compare these resources in context with the resources in other Caribbean countries. The DR has 12 centers with 19 linear accelerators, 1 Cobalt-60 (Co-60) teletherapy unit, 2 Co-60 stereotactic units. High-dose rate (HDR) brachytherapy is offered at 4 sites and low-dose rate (LDR) brachytherapy is offered at 1 site. Staffing in the DR includes 26 radiation oncologists, 12 medical physicists, and 12 dosimetrists. On assessment, the DR has a sufficient number of radiotherapy machines, but needs six additional physicians and physicists. In comparison to other Caribbean countries, the DR contains the most radiotherapy centers and machines with the latest technology. Notably Haiti, the third most populous Caribbean country, has no radiotherapy resources. As many Caribbean countries do not have radiotherapy centers, patients may travel elsewhere to receive radiotherapy. If only considering the countries that are not territories of mainland countries, with the exception of Puerto Rico and Martinique that do have radiotherapy centers, an additional 47 teletherapy machines are needed in the Caribbean, reflecting a 40% increase. The DR has emerged as a leader of radiotherapy resources in the Caribbean. Understanding of the radiotherapy resources in the DR is important as Caribbean countries without radiotherapy resources, such as Haiti, utilize the same resources. The DR has a robust radiotherapy program, but does not have enough resources to compensate for patients from other Caribbean countries that lack radiotherapy resources.