title: Radiation therapy infrastructure and human resources in low- and middle-income countries: present status and projections for 2020.
abstract: OBJECTIVE
  Radiation therapy, a key component of cancer management, is required in more than half of new cancer patients, particularly in low- and middle-income countries (LMICs). The projected rise in cancer incidence over the next decades in LMICs will result in an increasing demand for radiation therapy services. Considering the present cancer incidence and that projected for 2020 (as listed in GLOBOCAN), we evaluated the current and anticipated needs for radiation therapy infrastructure and staffing by 2020 for each of the LMICs.
  
  
  METHODS
  Based on World Bank classification, 139 countries fall in the category of LMICs. Details of teletherapy, radiation oncologists, medical physicists, and radiation therapy technologists were available for 84 LMICs from the International Atomic Energy Agency-Directory of Radiotherapy Centres (IAEA-DIRAC) database. Present requirements and those for 2020 were estimated according to recommendations from the IAEA and European Society for Radiotherapy & Oncology (ESTRO-QUARTS).
  
  
  RESULTS
  Only 4 of the 139 LMICs have the requisite number of teletherapy units, and 55 (39.5%) have no radiation therapy facilities at present. Patient access to radiation therapy in the remaining 80 LMICs ranges from 2.3% to 98.8% (median: 36.7%). By 2020, these 84 LMICs would additionally need 9169 teletherapy units, 12,149 radiation oncologists, 9915 medical physicists, and 29,140 radiation therapy technologists. Moreover, de novo radiation therapy facilities would have to be considered for those with no services.
  
  
  CONCLUSIONS
  Twelve pragmatic steps are proposed for consideration at national and international levels to narrow the gap in radiation therapy access. Multipronged and coordinated action from all national and international stakeholders is required to develop realistic strategies to curb this impending global crisis.
authors.affiliation: Centre for Radiation Oncology, Kantonsspital Aarau - Kantonsspital Baden, Kantonsspital Aarau, Aarau, Switzerland. Electronic address: niloyranjan.datta@ksa.ch.
authors.forename: Niloy R
authors.initials: NR
authors.lastname: Datta
authors.affiliation: Consultancy Practice, Vienna, Austria.
authors.forename: Massoud
authors.initials: M
authors.lastname: Samiei
authors.affiliation: Centre for Radiation Oncology, Kantonsspital Aarau - Kantonsspital Baden, Kantonsspital Aarau, Aarau, Switzerland, and Department of Radiation Oncology, University Hospital Zurich, Switzerland.
authors.forename: Stephan
authors.initials: S
authors.lastname: Bodis
mesh_terms: D002173:Cancer Care Facilities / Q000592:standards / Q000600:supply & distribution; D016208:Databases, Factual / Q000706:statistics & numerical data; D003906:Developing Countries / Q000145:classification / Q000706:statistics & numerical data*; D005544:Forecasting; D014943:Global Health; D006297:Health Services Accessibility / Q000706:statistics & numerical data / Q000639:trends; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data / Q000639:trends*; D006801:Humans; D015994:Incidence; D009369:Neoplasms / Q000453:epidemiology / Q000517:prevention & control / Q000532:radiotherapy*; D018787:Radiation Oncology / Q000295:instrumentation / Q000706:statistics & numerical data / Q000639:trends*; D011871:Radiology / Q000639:trends; D000078329:Workforce