Christ Sebastian M, Willmann Jonas
Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Switzerland.
Adv Radiat Oncol. 2023 Mar 1;8(4):101175. doi: 10.1016/j.adro.2023.101175. eCollection 2023 Jul-Aug.
Although radiation therapy (RT) is an effective and inexpensive pillar of multidisciplinary cancer care, access to RT facilities remains highly inequitable globally. Numerous studies have documented this resource gap, yet many countries continue facing their raging cancer epidemics ill-equipped. In this study, we present an estimation of resource deficits in low- and middle-income countries (LMICs) without any RT facilities at all.
This study builds on publicly available data on country classification, population, cancer incidence, and RT requirements provided by the World Bank Group, the World Health Organization, and the International Atomic Energy Agency. Leveraging these data, we developed a capacity-planning model to estimate the current deficit of fundamental RT resources for LMICs with more than 1 million inhabitants and no active RT facilities.
There were 23 LMICs with a population of more than 1 million inhabitants and without any active RT facilities, 78% of which were located in sub-Saharan Africa. The aggregate population of these countries was 197.3 million people. The largest countries without RT facilities were Afghanistan and Malawi, with a population of 38.0 million and 18.6 million inhabitants, respectively. Estimated cancer incidence for all countries under study totaled at 134,783 new cases per year, 84,239 (62.5%) of which would have required RT. There was an aggregate deficit of 188 megavoltage machines and 85 brachytherapy afterloaders, along with simulation equipment and human capital in the magnitude of approximately 3363 trained radiation oncology staff.
Hundreds of thousands of patients with cancer in LMICs continue to live in countries without access to RT in their own country. This extreme form of global health inequity requires urgent and decisive action, the success of which depends on the integration of international and local efforts.
尽管放射治疗（RT）是多学科癌症治疗中有效且经济的支柱，但全球范围内放射治疗设施的可及性仍然极不均衡。众多研究记录了这种资源差距，然而许多国家在应对肆虐的癌症流行时仍设备不足。在本研究中，我们对完全没有任何放射治疗设施的低收入和中等收入国家（LMICs）的资源短缺情况进行了估计。
本研究基于世界银行集团、世界卫生组织和国际原子能机构提供的关于国家分类、人口、癌症发病率和放射治疗需求的公开数据。利用这些数据，我们开发了一个能力规划模型，以估计居民超过100万且没有现役放射治疗设施的低收入和中等收入国家基本放射治疗资源的当前短缺情况。
有23个居民超过100万且没有任何现役放射治疗设施的低收入和中等收入国家，其中78%位于撒哈拉以南非洲。这些国家的总人口为1.973亿人。没有放射治疗设施的最大国家是阿富汗和马拉维，人口分别为3800万和1860万居民。所有研究国家的估计癌症发病率总计为每年134783例新病例，其中84239例（62.5%）需要放射治疗。总共短缺188台兆伏级机器和85台近距离放射治疗后装设备，以及模拟设备和人力资本，数量约为3363名经过培训的放射肿瘤学工作人员。
低收入和中等收入国家成千上万的癌症患者仍生活在无法在本国获得放射治疗的国家。这种极端形式的全球卫生不平等需要紧急和果断的行动，其成功取决于国际和地方努力的整合。
