title: The Benefits of Providing External Beam Radiotherapy in Low- and Middle-income Countries.
abstract: More than half of all cancer diagnoses worldwide occur in low- and middle-income countries (LMICs) and the incidence is projected to rise substantially within the next 20 years. Radiotherapy is a vital, cost-effective treatment for cancer; yet there is currently a huge deficit in radiotherapy services within these countries. The aim of this study was to estimate the potential outcome benefits if external beam radiotherapy was provided to all patients requiring such treatment in LMICs, according to the current evidence-based guidelines. Projected estimates of these benefits were calculated to 2035, obtained by applying the previously published Collaboration for Cancer Outcomes, Research and Evaluation (CCORE) demand and outcome benefit estimates to cancer incidence and projection data from the GLOBOCAN 2012 data. The estimated optimal radiotherapy utilisation rate for all LMICs was 50%. There were about 4.0 million cancer patients in LMICs who required radiotherapy in 2012. This number is projected to increase by 78% by 2035, a far steeper increase than the 38% increase expected in high-income countries. National radiotherapy benefits varied widely, and were influenced by case mix. The 5 year population local control and survival benefits for all LMICs, if radiotherapy was delivered according to guidelines, were estimated to be 9.6% and 4.4%, respectively, compared with no radiotherapy use. This equates to about 1.3 million patients who would derive a local control benefit in 2035, whereas over 615 000 patients would derive a survival benefit if the demand for radiotherapy in LMICs was met. The potential outcome benefits were found to be higher in LMICs. These results further highlight the urgent need to reduce the gap between the supply of, and demand for, radiotherapy in LMICs. We must attempt to address this 'silent crisis' as a matter of priority and the approach must consider the complex societal challenges unique to LMICs.
authors.affiliation: Ingham Institute for Applied Medical Research, University of New South Wales, Liverpool, New South Wales, Australia; Liverpool and Macarthur Cancer Therapy Centres, Western Sydney University, Campbelltown, New South Wales, Australia. Electronic address: mei.yap@sswahs.nsw.gov.au.
authors.forename: M L
authors.initials: ML
authors.lastname: Yap
authors.affiliation: Ingham Institute for Applied Medical Research, University of New South Wales, Liverpool, New South Wales, Australia; Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada.
authors.forename: T P
authors.initials: TP
authors.lastname: Hanna
authors.affiliation: Ingham Institute for Applied Medical Research, University of New South Wales, Liverpool, New South Wales, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Shafiq
authors.affiliation: International Agency for Research on Cancer, Lyon, France.
authors.forename: J
authors.initials: J
authors.lastname: Ferlay
authors.affiliation: International Agency for Research on Cancer, Lyon, France.
authors.forename: F
authors.initials: F
authors.lastname: Bray
authors.affiliation: Ingham Institute for Applied Medical Research, University of New South Wales, Liverpool, New South Wales, Australia; Liverpool and Macarthur Cancer Therapy Centres, Western Sydney University, Campbelltown, New South Wales, Australia.
authors.forename: G P
authors.initials: GP
authors.lastname: Delaney
authors.affiliation: Ingham Institute for Applied Medical Research, University of New South Wales, Liverpool, New South Wales, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Barton
mesh_terms: D003906:Developing Countries; D005544:Forecasting; D006301:Health Services Needs and Demand; D006801:Humans; D009369:Neoplasms / Q000532:radiotherapy*; D011878:Radiotherapy / Q000706:statistics & numerical data*; D016896:Treatment Outcome
keywords: Developing countries; global oncology; low- and middle-income countries; outcome benefits; radiotherapy; radiotherapy utilisation