Abstract
BackgroundAccess and availability of radiotherapy treatment is limited in most low- and middle-income countries, which leads to long waiting times and poor clinical outcomes. The aim of our study is to determine the magnitude of waiting times for radiotherapy in a resource-limited setting.MethodsThis is a retrospective cohort study of patients with the five most commonly treated cancers managed with radiotherapy between 2010 and 2014. Data includes diagnosis, patients’ demographics and treatment provided. The waiting time was categorised into intervals (1) between diagnosis and first radiation consultation (2) First consultation to radiotherapy treatment (3) Decision-to-treat to treatment and (4) Diagnosis to treatment.ResultsA total of 258 cases were involved, including cervical (50%; 129/258), breast (27.5%; 71/258), nasopharynx (12.8%; 33/258), colorectal (5%; 13/258) and prostate cancers (4.7%; 12/258). Mean age was 48 (±12.9) years. Treatment with radical intent comprised 67% (178/258) of cases, while 33% (80/258) had palliative treatment. The median time from diagnosis to first radiation consultation was 40 (IQR 17–157.75) days for all the patients, with prostate cancer having the longest time – 305 days (IQR 41–393.8). The median time between the first radiation oncology consultations and first radiotherapy treatment was 130.5 (IQR 14–211.5) days; cervical cancer patients waited a median of 139 (IQR 13–195.5) days. The median time between diagnosis and first radiotherapy for breast cancer patients was 329 (IQR 207–464) days, compared to 213 (IQR 101.5–353.5) days for all the patients.ConclusionThe study shows that waiting time for radiotherapy in Nigeria was generally longer than what is recommended internationally. This reflects the need to improve access to radiotherapy in order to improve cancer treatment outcomes in resource-limited settings.
Highlights
Access and availability of radiotherapy treatment is limited in most low- and middle-income countries, which leads to long waiting times and poor clinical outcomes
The median time from diagnosis to radiation oncology consultation (WT1) is 6 (IQR 2–30] weeks with 90% of cases being seen within 43 weeks (≈10 months) after diagnosis
The median time from radiation oncology consultation to radiotherapy (WT2) is 19 (IQR 2–22) weeks which varies significantly across the cancer sites/diagnosis (p value = 0.000). prostate being the least with a median of 1 (IQR 0-8] weeks while nasopharynx was 28 (IQR 15–37) weeks. 90% of cases waited for 91weeks
Summary
Access and availability of radiotherapy treatment is limited in most low- and middle-income countries, which leads to long waiting times and poor clinical outcomes. Radiotherapy is an important component of modern cancer treatment, with an estimated 50%–60% of all cancer cases receiving it during the course of their treatment Access to this vital modality of cancer treatment is limited or even absent in most low- and middle-income countries (LMICs), especially in sub-Saharan Africa. The fundamental reason for long waiting times for radiotherapy is the increasing demand for radiotherapy due to raising cancer incidence in LMICs as shown by epidemiological studies and the recent GLOBACAN 2018 reports published by the International Agency for Research on Cancer. Other factors include insufficient radiotherapy professionals (radiation oncologist, medical physics, therapy radiographers and mould room technicians), increasing complexity in the treatment process, poor maintenance which increases machine downtime and frequent strike action by health care professionals to demand for better working conditions and remuneration [7, 8]
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