Data for this review were identified by searches of Ovid, PubMed, and references from relevant articles, with the search terms ‘radiotherapy’, ‘cost’, ‘cost-effectiveness’, ‘developed countries’, and ‘developing countries’. Abstracts and reports from meetings were not included. Only reports published in English between 1990 and 2005 were included.
Health-care ResearchRole of radiotherapy in cancer control in low-income and middle-income countries
Section snippets
Estimating need for radiotherapy
Radiotherapy has a part to play in the treatment of nearly all types of cancer. We have investigated its use in the treatment of every malignant disease that makes up 1% or more of all cancers notified to central cancer registries.4 Radiotherapy was indicated if it was the treatment of choice because it offered the best chance of cure, best improvement in local cancer control, best palliation, fewest side-effects, or a combination of these factors. These data were combined with epidemiological
Current status of radiotherapy services in low-income and middle-income countries
The amount of radiotherapy services available in countries of low and middle income varies greatly: many have no radiotherapy service; others have old or poorly functioning services restricted to a few centres. The major determinants of the level of radiotherapy service provided seem to be the ratio of gross national income per person (figure 3) and population size.22
Findings of a survey22 of 72 low-income and middle-income countries showed that 24 countries with populations of more than 1
Strategies to improve radiotherapy services
The review of available data for cancer services shows that many countries do not have effective radiotherapy services for cancer treatment, many regions have very limited facilities that will not be able to deal with more than a few cases, and the many areas with reasonable amounts of equipment might have shortages of staff or planning equipment that prevents them delivering safe effective radiotherapy. A strategy to improve radiotherapy services must be multipronged and flexible. It must
Conclusion
Radiotherapy is an essential part of multidisciplinary cancer care and can be delivered effectively, safely, and cost effectively in low-income and middle-income countries. About half of all cancer patients would benefit from at least one course of radiotherapy. This treatment is most useful when others (such as surgery and chemotherapy) are also available. People with cancer in many countries of low and middle income do not have any access to radiotherapy, and for most individuals,
Search strategy and selection criteria
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