title: The power of integration: radiotherapy and global palliative care.
abstract: Radiotherapy (RT) is a powerful tool for the palliation of the symptoms of advanced cancer, although access to it is limited or absent in many low- and middle-income countries (LMICs). There are multiple factors contributing to this, including assumptions about the economic feasibility of RT in LMICs, the logical challenges of building capacity to deliver it in those regions, and the lack of political support to drive change of this kind. It is encouraging that the problem of RT access has begun to be included in the global discourse on cancer control and that palliative care and RT have been incorporated into national cancer control plans in some LMICs. Further, RT twinning programs involving high- and low-resource settings have been established to improve knowledge transfer and exchange. However, without large-scale action, the consequences of limited access to RT in LMICs will become dire. The number of new cancer cases around the world is expected to double by 2030, with twice as many deaths occurring in LMICs as in high-income countries (HICs). A sustained and coordinated effort involving research, education, and advocacy is required to engage global institutions, universities, health care providers, policymakers, and private industry in the urgent need to build RT capacity and delivery in LMICs.
authors.affiliation: Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada. danielle.rodin@rmp.uhn.on.ca.
authors.forename: Danielle
authors.initials: D
authors.lastname: Rodin
authors.affiliation: Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Surbhi
authors.initials: S
authors.lastname: Grover
authors.affiliation: Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Shekinah N
authors.initials: SN
authors.lastname: Elmore
authors.affiliation: Miami Institute for the Americas, University of Miami, Miami, FL, USA.
authors.forename: Felicia M
authors.initials: FM
authors.lastname: Knaul
authors.affiliation: Department of Global Health and Population, Harvard School of Public Health, Harvard University, Boston, MA, USA.
authors.forename: Rifat
authors.initials: R
authors.lastname: Atun
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, University of Ottawa, Ottawa, Canada.
authors.forename: Lisa
authors.initials: L
authors.lastname: Caulley
authors.affiliation: Department of Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Cristian A
authors.initials: CA
authors.lastname: Herrera
authors.affiliation: Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Jones
authors.affiliation: University of Toronto, Toronto, ON, Canada.
authors.forename: Aryeh J
authors.initials: AJ
authors.lastname: Price
authors.affiliation: Fortis Memorial Research Institute, Gurgaon, India.
authors.forename: Anusheel
authors.initials: A
authors.lastname: Munshi
authors.affiliation: All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Ajeet K
authors.initials: AK
authors.lastname: Gandhi
authors.affiliation: Cancer Care Kenya, M.P. Shah Hospital, Nairobi, Kenya.
authors.forename: Chiman
authors.initials: C
authors.lastname: Shah
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada.
authors.forename: Mary
authors.initials: M
authors.lastname: Gospodarowicz
mesh_terms: D000553:Ambulatory Care / Q000458:organization & administration; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration; D003906:Developing Countries; D014943:Global Health; D006291:Health Policy; D006801:Humans; D009369:Neoplasms / Q000532:radiotherapy*; D010166:Palliative Care / Q000379:methods*; D017149:Private Sector / Q000458:organization & administration; D017150:Public Sector / Q000458:organization & administration; D055818:Public-Private Sector Partnerships
keywords: Radiotherapy (RT); developing countries; global health; palliative care