Bridging the cancer care gap and inequities in radiation treatment in India: A narrative review

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Cancer is the fifth leading cause of death in India, yet India's cancer care landscape remains fragmented. In this paper, we review the current state of access to radiation therapy and the inequities involved, as well as identify potential solutions to improve access to radiation therapy in cancer. We undertook this narrative literature review, which encompassed database searches (PubMed, Embase, Scopus) and scrutiny of the grey literature (Google Scholar, OpenGrey), using the search terms: “cancer care access disparities,” “radiotherapy accessibility challenges,” “out-of-pocket expenditure in cancer treatment,” “value-based cancer care models,” “cost-effective radiotherapy strategies,”and“resource-limited cancer care solutions.” Our search strategy focused on articles addressing barriers to radiation treatment, inequities in radiation treatment equipment, and optimal radiation techniques in resource-limited settings in India, thereby identifying key challenges and potential interventions. Of the 1933 articles initially retrieved, we included 46 for the preparation of this review. Among the various modalities utilized for the management of cancer, radiation treatment is the most resource-intensive, requiring expensive and dedicated infrastructure. Scarce infrastructure, perpetuating inequities across geographical regions and socioeconomic strata, is responsible for inequities in access to radiation treatment in India. With the advent of newer radiation techniques requiring specialized equipment for the delivery of advanced radiation treatment, these inequities widen in low- and middle-income countries such as India. The challenge lies in providing affordable and equitable radiation treatment without compromising on quality within India's diverse and populous expanse. Bridging these gaps mandates the improvement of the existing infrastructure, fostering local production of quality medical equipment like linear accelerators, establishing and adhering to country-specific standardized treatment guidelines based on volumes, optimally utilizing available equipment like indigenous telecobalt machines and cost-effectiveness evidence, establishment of rural cancer care centers, optimization of private sector capacities and economic support through national insurance schemes.