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Beckett M, Al Balushi M, Chan J, Iakovenko V, Roumeliotis M, Hanna T, Huang F, Barkati M, Rodin D, Bourque JM. Pan-Canadian Survey of Radiation Oncology Professional Involvement in Global Oncology Initiatives in Low- and Middle-Income Countries. JCO Glob Oncol 2024; 10:e2300174. [PMID: 38574301 PMCID: PMC11003509 DOI: 10.1200/go.23.00174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 12/18/2023] [Accepted: 01/30/2024] [Indexed: 04/06/2024] Open
Abstract
PURPOSE Canadian radiation oncology professionals have a strong history of involvement in global oncology initiatives worldwide. This pan-Canadian survey-based study was conducted to determine the current level of engagement of Canadian radiation oncologists (ROs) and medical physicists (MPs) in global oncology initiatives and broaden the development of these activities. MATERIALS AND METHODS This was a cross-sectional study. The survey was designed to characterize current levels of engagement of Canadian ROs and MPs in global oncology initiatives. The survey was open from March 2019 to April 2020. It was disseminated to all Canadian Association of Radiation Oncology and Canadian Organization of Medical Physicists members with two subsequent email reminders. RESULTS Survey responses were received from 40 (93%) of the 43 Canadian cancer treatment centers that offer radiotherapy. At least one RO responded at 34 centers (79%) and one MP from 34 centers (79%) with some overlap. A response was received from a total of 93 participants, 47 ROs and 46 MPs. Of all survey participants, 58% reported some experience with global oncology. Nineteen percent of the participants surveyed were currently directly involved in short- or long-term projects, more than half of which have opportunity for additional staff involvement. The projects spanned 26 countries in South America, Africa, and Asia. Quality improvement and capacity building accounted for 27% and 20% of initiatives, respectively. The most common area of engagement was in direct treatment care, accounting for 56% of the projects. CONCLUSION This study demonstrates the landscape of involvement of Canadian ROs and MPs in global oncology initiatives. The study also highlights areas of opportunity for broadening international participation and collaboration as it relates to global oncology for Canadian radiation oncology professionals.
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Affiliation(s)
- Matthew Beckett
- Division of Radiation Oncology, The Ottawa Hospital, Ottawa, ON, Canada
- University of Ottawa Faculty of Medicine, Ottawa, ON, Canada
| | | | - Jessica Chan
- Division of Radiation Oncology, University of British Columbia, Vancouver, BC, Canada
| | | | - Michael Roumeliotis
- Department of Physics and Astronomy, University of Calgary, Calgary, AB, Canada
| | - Tim Hanna
- Cancer Research Institute, Queens University, Kingston, ON, Canada
| | - Fleur Huang
- Department of Oncology, University of Alberta, Edmonton, AB, Canada
| | - Maroie Barkati
- Departement de Radio-oncologie, Université de Montréal, Montreal, QC, Canada
| | - Danielle Rodin
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Jean-Marc Bourque
- Departement de Radio-oncologie, Université de Montréal, Montreal, QC, Canada
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2
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Jaffray DA, Knaul F, Baumann M, Gospodarowicz M. Harnessing progress in radiotherapy for global cancer control. NATURE CANCER 2023; 4:1228-1238. [PMID: 37749355 DOI: 10.1038/s43018-023-00619-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 06/22/2023] [Indexed: 09/27/2023]
Abstract
The pace of technological innovation over the past three decades has transformed the field of radiotherapy into one of the most technologically intense disciplines in medicine. However, the global barriers to access this highly effective treatment are complex and extend beyond technological limitations. Here, we review the technological advancement and current status of radiotherapy and discuss the efforts of the global radiation oncology community to formulate a more integrative 'diagonal approach' in which the agendas of science-driven advances in individual outcomes and the sociotechnological task of global cancer control can be aligned to bring the benefit of this proven therapy to patients with cancer everywhere.
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Affiliation(s)
- David A Jaffray
- Departments of Radiation Physics and Imaging Physics, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Felicia Knaul
- Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL, USA
| | | | - Mary Gospodarowicz
- Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
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3
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Rubagumya F, Mushonga M, Abdihamid O, Nyagabona S, Hopman W, Nwamaka L, Omar AA, Ndlovu N, Booth C, Aggarwal A, Brundage M, Vanderpuye V, de Moraes FY. Status of Peer Review in Radiation Oncology: A Survey of Cancer Centers in Sub-Saharan Africa. Int J Radiat Oncol Biol Phys 2023; 116:984-991. [PMID: 37453798 DOI: 10.1016/j.ijrobp.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 04/06/2023] [Accepted: 04/11/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Fidel Rubagumya
- Department of Oncology, Rwanda Military Hospital, Kigali, Rwanda; Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada; Departments of Oncology and; Public Health Sciences, Queen's University, Kingston, Ontario, Canada.
| | - Melinda Mushonga
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Omar Abdihamid
- Garissa Cancer Center-Garissa County Referral Hospital, Garissa, Kenya
| | - Sarah Nyagabona
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Wilma Hopman
- Public Health Sciences, Queen's University, Kingston, Ontario, Canada; Kingston Health Sciences Centre Research Institute, Kingston, Ontario, Canada
| | | | - Abeid Athman Omar
- Kenyatta University Teaching Research and Referral Hospital, Nairobi, Kenya
| | - Ntokozo Ndlovu
- Parirenyatwa Hospital Radiotherapy Centre, Harare, Zimbabwe
| | - Christopher Booth
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada; Departments of Oncology and; Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Ajay Aggarwal
- Institute of Cancer Policy, King's College London, London, United Kingdom; London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Michael Brundage
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada; Departments of Oncology and
| | | | - Fabio Ynoe de Moraes
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada; Departments of Oncology and
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4
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Ngwa W, Addai BW, Adewole I, Ainsworth V, Alaro J, Alatise OI, Ali Z, Anderson BO, Anorlu R, Avery S, Barango P, Bih N, Booth CM, Brawley OW, Dangou JM, Denny L, Dent J, Elmore SNC, Elzawawy A, Gashumba D, Geel J, Graef K, Gupta S, Gueye SM, Hammad N, Hessissen L, Ilbawi AM, Kambugu J, Kozlakidis Z, Manga S, Maree L, Mohammed SI, Msadabwe S, Mutebi M, Nakaganda A, Ndlovu N, Ndoh K, Ndumbalo J, Ngoma M, Ngoma T, Ntizimira C, Rebbeck TR, Renner L, Romanoff A, Rubagumya F, Sayed S, Sud S, Simonds H, Sullivan R, Swanson W, Vanderpuye V, Wiafe B, Kerr D. Cancer in sub-Saharan Africa: a Lancet Oncology Commission. Lancet Oncol 2022; 23:e251-e312. [PMID: 35550267 PMCID: PMC9393090 DOI: 10.1016/s1470-2045(21)00720-8] [Citation(s) in RCA: 158] [Impact Index Per Article: 52.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 12/02/2021] [Accepted: 12/06/2021] [Indexed: 01/13/2023]
Abstract
In sub-Saharan Africa (SSA), urgent action is needed to curb a growing crisis in cancer incidence and mortality. Without rapid interventions, data estimates show a major increase in cancer mortality from 520 348 in 2020 to about 1 million deaths per year by 2030. Here, we detail the state of cancer in SSA, recommend key actions on the basis of analysis, and highlight case studies and successful models that can be emulated, adapted, or improved across the region to reduce the growing cancer crises. Recommended actions begin with the need to develop or update national cancer control plans in each country. Plans must include childhood cancer plans, managing comorbidities such as HIV and malnutrition, a reliable and predictable supply of medication, and the provision of psychosocial, supportive, and palliative care. Plans should also engage traditional, complementary, and alternative medical practices employed by more than 80% of SSA populations and pathways to reduce missed diagnoses and late referrals. More substantial investment is needed in developing cancer registries and cancer diagnostics for core cancer tests. We show that investments in, and increased adoption of, some approaches used during the COVID-19 pandemic, such as hypofractionated radiotherapy and telehealth, can substantially increase access to cancer care in Africa, accelerate cancer prevention and control efforts, increase survival, and save billions of US dollars over the next decade. The involvement of African First Ladies in cancer prevention efforts represents one practical approach that should be amplified across SSA. Moreover, investments in workforce training are crucial to prevent millions of avoidable deaths by 2030. We present a framework that can be used to strategically plan cancer research enhancement in SSA, with investments in research that can produce a return on investment and help drive policy and effective collaborations. Expansion of universal health coverage to incorporate cancer into essential benefits packages is also vital. Implementation of the recommended actions in this Commission will be crucial for reducing the growing cancer crises in SSA and achieving political commitments to the UN Sustainable Development Goals to reduce premature mortality from non-communicable diseases by a third by 2030.
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Affiliation(s)
- Wilfred Ngwa
- Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA; Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Department of Information and Sciences, ICT University, Yaoundé, Cameroon.
| | - Beatrice W Addai
- Breast Care International, Peace and Love Hospital, Kumasi, Ghana
| | - Isaac Adewole
- College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Victoria Ainsworth
- Department of Physics and Applied Physics, University of Massachusetts Lowell, Lowell, MA, USA
| | - James Alaro
- National Cancer Institute, National Institute of Health, Bethesda, MD, USA
| | | | - Zipporah Ali
- Kenya Hospices and Palliative Care Association, Nairobi, Kenya
| | - Benjamin O Anderson
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Non-communicable Diseases, WHO, Geneva, Switzerland
| | - Rose Anorlu
- Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Stephen Avery
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Prebo Barango
- WHO, Regional Office for Africa, Brazzaville, Republic of the Congo
| | - Noella Bih
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Christopher M Booth
- Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, ON, Canada
| | - Otis W Brawley
- Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | | | - Lynette Denny
- Department of Obstetrics and Gynaecology, University of Cape Town, Cape Town, South Africa; South African Medical Research Council, Gynaecological Cancer Research Centre, Tygerberg, South Africa
| | | | - Shekinah N C Elmore
- Department of Radiation Oncology, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Ahmed Elzawawy
- Department of Clinical Oncology, Suez Canal University, Ismailia, Egypt
| | | | - Jennifer Geel
- Division of Paediatric Haematology and Oncology, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Katy Graef
- BIO Ventures for Global Health, Seattle, WA, USA
| | - Sumit Gupta
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Nazik Hammad
- Department of Oncology, Queen's University, Kingston, ON, Canada
| | - Laila Hessissen
- Pediatric Oncology Department, Pediatric Teaching Hospital, Rabat, Morocco
| | - Andre M Ilbawi
- Department of Non-communicable Diseases, WHO, Geneva, Switzerland
| | - Joyce Kambugu
- Department of Pediatrics, Uganda Cancer Institute, Kampala, Uganda
| | - Zisis Kozlakidis
- Laboratory Services and Biobank Group, International Agency for Research on Cancer, WHO, Lyon, France
| | - Simon Manga
- Cameroon Baptist Convention Health Services, Bamenda, Cameroon
| | - Lize Maree
- Department of Nursing Education, University of the Witwatersrand, Johannesburg, South Africa
| | - Sulma I Mohammed
- Department of Comparative Pathobiology, Center for Cancer Research, Purdue University, West Lafayette, IN, USA
| | - Susan Msadabwe
- Department of Radiation Therapy, Cancer Diseases Hospital, Lusaka, Zambia
| | - Miriam Mutebi
- Department of Surgery, Aga Khan University Hospital, Nairobi, Kenya
| | | | - Ntokozo Ndlovu
- Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Kingsley Ndoh
- Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Mamsau Ngoma
- Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | - Twalib Ngoma
- Department of Clinical Oncology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Timothy R Rebbeck
- Dana-Farber Cancer Institute, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Lorna Renner
- Department of Paediatrics, University of Ghana School of Medicine and Dentistry, Accra, Ghana
| | - Anya Romanoff
- Department of Health System Design and Global Health, Icahn School of Medicine, The Mount Sinai Hospital, New York, NY, USA
| | - Fidel Rubagumya
- Department of Oncology, Rwanda Military Hospital, Kigali, Rwanda; University of Global Health Equity, Kigali, Rwanda
| | - Shahin Sayed
- Department of Pathology, Aga Khan University Hospital, Nairobi, Kenya
| | - Shivani Sud
- Department of Radiation Oncology, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Hannah Simonds
- Division of Radiation Oncology, Tygerberg Hospital and University of Stellenbosch, Stellenbosch, South Africa
| | | | - William Swanson
- Department of Physics and Applied Physics, Dana-Farber Cancer Institute, University of Massachusetts Lowell, Lowell, MA, USA
| | - Verna Vanderpuye
- National Centre for Radiotherapy, Oncology, and Nuclear Medicine, Korle Bu Teaching Hospital, Accra, Ghana
| | | | - David Kerr
- Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
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5
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Jensen K, Dalby RB, Bouchelouche K, Pedersen EM, Kalmar S. Telehealth in Multidisciplinary Target Delineation for Radiotherapy During the COVID-19 Pandemic. A Review and a Case. Semin Nucl Med 2022; 52:79-85. [PMID: 34217435 PMCID: PMC8206582 DOI: 10.1053/j.semnuclmed.2021.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Like all other medical specialties, radiotherapy has been deeply influenced by the COVID-19 pandemic. The pandemic has had severe influence on the entire patient trajectory in oncology, from diagnosis to treatment and follow-up. Many examples of how to deal with patient and staff safety, shortness of staff and other resources and the quest to continue high-quality, evidence-based treatment have been presented. The use of telemedicine and telehealth is frequently presented as a part of the solution to overcome these challenges. Some of the available presented solutions will only apply in an acute, local setting, whereas others might inspire the community to improve quality and cost-effectiveness of radiotherapy as well as knowledge sharing in the future. Some of the unresolved issues in many of the available technical solutions are related to data security and public regulation, for example, GDPR (General Data Protection Regulation) in the EU and HIPAA compliance (Health Insurance Portability and Accountability Act) in the USA. Using a solution that involves a supplier's server in a non-EU country is problematic within the EU. In this paper we shortly review the influence of COVID-19 on radiotherapy. We describe some of the possible solutions for telehealth in target delineation - a crucial part of high-quality radiotherapy, which often requires multidisciplinary effort, hands-on corporation, and high-quality multimodal imaging. Hereafter, our own technical solution will be presented as a case.
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Affiliation(s)
- Kenneth Jensen
- Danish Center for Particle Therapy, Aarhus University Hospital, Denmark,Address reprint requests to: Kenneth Jensen MD, PhD, Danish Center for Particle Therapy, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | | | - Kirsten Bouchelouche
- Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, Denmark
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Chofor N, Bopda P, Bücker R, Ivo A, Okonkwo E, Joel K, Tung Z, Ige T, Wirtz H, Ngwa W. Mobilising stakeholders to improve access to state-of-the-art radiotherapy in low- and middle-income countries. Ecancermedicalscience 2021; 15:1227. [PMID: 34158831 PMCID: PMC8183652 DOI: 10.3332/ecancer.2021.1227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Indexed: 12/24/2022] Open
Abstract
In an ongoing effort to improve access to state-of-the-art radiotherapy in low- and middle-income countries (LMICs), a joint symposium was organised by the non-governmental, non-profit organisation Medical physicists in diaspora for Africa e.V. (MephidA e.V.) in collaboration with the Germany-based Cameroon-German medical doctor’s association (Camfomedics e.V.) and the Harvard-based Global Health Catalyst summit. The goal of the symposium was to discuss the technical and structural challenges faced in African LMIC settings, re-evaluate strategies to overcome the shortfall of radiotherapy services and ameliorate the situation. The meeting brought together industry partners, including radiotherapy machine vendors and dosimetry solution providers, alongside public health, oncology and medical physics experts. This paper summarises the deliberations and recommendations based on the ongoing efforts including the use of information and communication technologies towards the provision of expert knowledge and telemedicine, the use of solar energy to avoid power outages and the use of high-end technology for enhanced quality assurance. We also present the experiences on the first linac installation at the Rwanda Military Hospital, the challenges faced in this LMIC as well as the patient’s demography, reflecting the reality in most sub-Saharan LMICs.
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Affiliation(s)
| | - Pierre Bopda
- Strahlentherapie Agaplesion Diakonieklinikum Rotenburg, Elise-Averdieck-Str. 17, 27356 Rotenburg, Germany
| | - Rebecca Bücker
- Strahlentherapie Klinikum Lippe GmbH, Rintelner Straße 85, 32657 Lemgo, Germany
| | - Azeh Ivo
- Onkologische Praxis und Tagesklinik, Ahstr. 2, 45879 Gelsenkirchen, Germany
| | - Ernest Okonkwo
- Strahlentherapie Ortenau Klinikum, Weingartenstr. 70, 77654 Offenburg, Germany
| | - Kra Joel
- Radiotherapy Department, Military Hospital, PO Box 3377, Kigali, Rwanda
| | - Zanzem Tung
- Zentrum für Strahlentherapie und Radioonkologie, Mozartstraße 30, 26655 Westerstede, Germany
| | - Taofeeq Ige
- Medical Physics Department, National Hospital Abuja, Abuja, FCT 900001, Nigeria.,University of Abuja, Abuja, Nigeria
| | - Holger Wirtz
- Strahlentherapie Singen-Friedrichshafen, Virchowstraße 10b D-78224 Singen/Hohentwiel, Germany
| | - Wilfred Ngwa
- Harvard Medical School, Brigham and Women's Hospital, Dana Farber Cancer Institute, Boston, MA 02115, USA.,University of Massachusetts Lowell, Boston, MA 02115, USA
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7
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Asana L, Irabor C, Seppo S, Jean C, Ngoma T, Elzawawy A, Ngwa W. Using advanced information and communication technologies to advance oncology education in Africa. Ecancermedicalscience 2021; 15:1211. [PMID: 33912236 PMCID: PMC8057784 DOI: 10.3332/ecancer.2021.1211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Indexed: 12/24/2022] Open
Abstract
Background Recent work has highlighted the tremendous potential of information and communication technologies (ICTs) in advancing global oncology education, research and care. The COVID-19 pandemic has made the development of effective approaches for online education even more crucial. Here we assessed the readiness, interest and potential models for effective implementation of ICT-powered oncology education in Africa. Methods Building on previous work by the African Organisation for Research and Training in Cancer (AORTIC), a survey was conducted to assess the electronic learning (e-Learning) readiness of oncology health professionals using an online self-assessment tool. Components of e-Learning readiness assessed include access to computers, Internet, appropriate bandwidth and interest. As a practical test model, an ICT resource-intensive radiation oncology training programme was implemented via the Global Oncology University (GO-U) collaborative education platform. An analysis of results, challenges and opportunities resulting from these is discussed for advancing online oncology education in Africa. Results The survey showed over 92% of health professionals have access to computers, laptops or other technology that can allow them to participate in online education. Over 45% of oncology health professionals have already participated in some form of online education. Interest in online education was over 93%. Models for effective online learning in oncology include synchronous and asynchronous short-term courses for continuous education and long-term degree and residency programmes. There was a significant increase in skills level following the collaborative radiation oncology training model used by the GO-U platform. Conclusion Africa has the capacity to implement successful e-Learning in oncology, which is consistent with findings in previous work such as the AORTIC. Greater investment by institutions and governments is needed in terms of resources and policy changes to facilitate the implementation of effective online oncology training. Purposeful engagement of diaspora oncology health professionals with relevant cultural backgrounds as with some current collaborative efforts is highly recommended in helping turn brain drain into brain circulation.
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Affiliation(s)
- Lydia Asana
- Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Credit Irabor
- Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Samuel Seppo
- Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Chrystelle Jean
- Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.,University of Central Florida, USA, 4000 Central Florida Blvd, Orlando, FL 32816, USA
| | - Twalib Ngoma
- Muhimbili University of Health and Allied Science, Tanzania, United Nations Rd, Dar es Salaam, Tanzania
| | - Ahmed Elzawawy
- Suez Canal University, Suez Canal Region, Ismailia City, Egypt
| | - Wilfred Ngwa
- Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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8
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Lewis PJ, Amankwaa-Frempong E, Makwani H, Nsingo M, Addison ECDK, Acquah GF, Yusufu S, Makufa R, Edusa CE, Dharsee NJ, Grover S, Court LE, Palta JR, Kapoor R, Aggarwal A. Radiotherapy Planning and Peer Review in Sub-Saharan Africa: A Needs Assessment and Feasibility Study of Cloud-Based Technology to Enable Remote Peer Review and Training. JCO Glob Oncol 2021; 7:10-16. [PMID: 33405955 PMCID: PMC8081549 DOI: 10.1200/go.20.00188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Philippa J Lewis
- King's College, London, United Kingdom.,Guy's Cancer Centre, London, United Kingdom
| | | | | | | | | | | | - Shaid Yusufu
- Ocean Road Cancer Institute, Dar Es Salaam, Tanzania
| | | | | | | | | | - Laurence E Court
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Rishabh Kapoor
- Veterans Healthcare Administration National Radiation Oncology Program, Richmond, VA
| | - Ajay Aggarwal
- King's College, London, United Kingdom.,Guy's Cancer Centre, London, United Kingdom
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9
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Yan M, Gouveia AG, Cury FL, Moideen N, Bratti VF, Patrocinio H, Berlin A, Mendez LC, Moraes FY. Practical considerations for prostate hypofractionation in the developing world. Nat Rev Urol 2021; 18:669-685. [PMID: 34389825 PMCID: PMC8361822 DOI: 10.1038/s41585-021-00498-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2021] [Indexed: 02/06/2023]
Abstract
External beam radiotherapy is an effective curative treatment option for localized prostate cancer, the most common cancer in men worldwide. However, conventionally fractionated courses of curative external beam radiotherapy are usually 8-9 weeks long, resulting in a substantial burden to patients and the health-care system. This problem is exacerbated in low-income and middle-income countries where health-care resources might be scarce and patient funds limited. Trials have shown a clinical equipoise between hypofractionated schedules of radiotherapy and conventionally fractionated treatments, with the advantage of drastically shortening treatment durations with the use of hypofractionation. The hypofractionated schedules are supported by modern consensus guidelines for implementation in clinical practice. Furthermore, several economic evaluations have shown improved cost effectiveness of hypofractionated therapy compared with conventional schedules. However, these techniques demand complex infrastructure and advanced personnel training. Thus, a number of practical considerations must be borne in mind when implementing hypofractionation in low-income and middle-income countries, but the potential gain in the treatment of this patient population is substantial.
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Affiliation(s)
- Michael Yan
- grid.410356.50000 0004 1936 8331Division of Radiation Oncology, Cancer Centre of Southeastern Ontario, Queen’s University, Kingston, Canada
| | - Andre G. Gouveia
- Department of Radiation Oncology, Americas Centro de Oncologia Integrado, Rio de Janeiro, Brazil
| | - Fabio L. Cury
- grid.14709.3b0000 0004 1936 8649Department of Radiation Oncology, Cedars Cancer Centre, McGill University, Montreal, Canada
| | - Nikitha Moideen
- grid.410356.50000 0004 1936 8331Division of Radiation Oncology, Cancer Centre of Southeastern Ontario, Queen’s University, Kingston, Canada
| | - Vanessa F. Bratti
- grid.410356.50000 0004 1936 8331Queen’s University School of Medicine, Department of Public Health Sciences, Kingston, Canada
| | - Horacio Patrocinio
- grid.14709.3b0000 0004 1936 8649Department of Medical Physics, Cedars Cancer Centre, McGill University, Montreal, Canada
| | - Alejandro Berlin
- grid.17063.330000 0001 2157 2938Radiation Medicine Program, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Lucas C. Mendez
- grid.39381.300000 0004 1936 8884Department of Radiation Oncology, London Regional Cancer Program, Western University, London, Canada
| | - Fabio Y. Moraes
- grid.410356.50000 0004 1936 8331Division of Radiation Oncology, Cancer Centre of Southeastern Ontario, Queen’s University, Kingston, Canada
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10
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Anacak Y, Zubizarreta E, Zaghloul M, Laskar S, Alert J, Gondhowiardjo S, Giselvania A, Correa-Villar R, Pedrosa F, Dorj B, Kamer S, Howard SC, Quintana Y, Ribeiro RC, Rosenblatt E, Hopkins K. The Practice of Paediatric Radiation Oncology in Low- and Middle-income Countries: Outcomes of an International Atomic Energy Agency Study. Clin Oncol (R Coll Radiol) 2020; 33:e211-e220. [PMID: 33250288 DOI: 10.1016/j.clon.2020.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 09/14/2020] [Accepted: 11/06/2020] [Indexed: 12/17/2022]
Abstract
AIMS Childhood cancer survival is suboptimal in most low- and middle-income countries (LMICs). Radiotherapy plays a significant role in the standard care of many patients. To assess the current status of paediatric radiotherapy, the International Atomic Energy Agency (IAEA) undertook a global survey and a review of practice in eight leading treatment centres in middle-income countries (MICs) under Coordinated Research Project E3.30.31; 'Paediatric radiation oncology practice in low and middle income countries: a patterns-of-care study by the International Atomic Energy Agency.' MATERIALS AND METHODS A survey of paediatric radiotherapy practices was distributed to 189 centres worldwide. Eight leading radiotherapy centres in MICs treating a significant number of children were selected and developed a database of individual patients treated in their centres comprising 46 variables related to radiotherapy technique. RESULTS Data were received from 134 radiotherapy centres in 42 countries. The percentage of children treated with curative intent fell sequentially from high-income countries (HICs; 82%) to low-income countries (53%). Increasing deficiencies were identified in diagnostic imaging, radiation staff numbers, radiotherapy technology and supportive care. More than 92.3% of centres in HICs practice multidisciplinary tumour board decision making, whereas only 65.5% of centres in LMICs use this process. Clinical guidelines were used in most centres. Practice in the eight specialist centres in MICs approximated more closely to that in HICs, but only 52% of patients were treated according to national/international protocols whereas institution-based protocols were used in 41%. CONCLUSIONS Quality levels in paediatric radiotherapy differ among countries but also between centres within countries. In many LMICs, resources are scarce, coordination with paediatric oncology is poor or non-existent and access to supportive care is limited. Multidisciplinary treatment planning enhances care and development may represent an area where external partners can help. Commitment to the use of protocols is evident, but current international guidelines may lack relevance; the development of resources that reflect the capacity and needs of LMICs is required. In some LMICs, there are already leading centres experienced in paediatric radiotherapy where patient care approximates to that in HICs. These centres have the potential to drive improvements in service, training, mentorship and research in their regions and ultimately to improve the care and outcomes for paediatric cancer patients.
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Affiliation(s)
- Y Anacak
- Ege University School of Medicine, Izmir, Turkey
| | | | - M Zaghloul
- National Cancer Institute, Cairo University, Cairo, Egypt; Children's Cancer Hospital, Cairo, Egypt
| | - S Laskar
- Tata Memorial Hospital, Mumbai, India
| | - J Alert
- Instituto de Oncología y Radiobiología, Habana, Cuba
| | - S Gondhowiardjo
- Faculty of Medicine, University of Indonesia/Dr Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - A Giselvania
- Faculty of Medicine, University of Indonesia/Dr Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | | | - F Pedrosa
- Instituto de Medicina Integral Prof. Fernando Figueira, Recife, Brazil
| | - B Dorj
- National Cancer Centre, Ulaanbaatar, Mongolia
| | - S Kamer
- Ege University School of Medicine, Izmir, Turkey
| | - S C Howard
- University of Tennessee Health Science Center, Memphis, TN, USA
| | | | - R C Ribeiro
- St Jude Children's Research Hospital, Memphis, TN, USA
| | - E Rosenblatt
- International Atomic Energy Agency, Vienna, Austria
| | - K Hopkins
- International Atomic Energy Agency, Vienna, Austria.
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Ngwa W, Olver I, Schmeler KM. The Use of Health-Related Technology to Reduce the Gap Between Developed and Undeveloped Regions Around the Globe. Am Soc Clin Oncol Educ Book 2020; 40:1-10. [PMID: 32223667 DOI: 10.1200/edbk_288613] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Cancer is the second leading cause of death worldwide, with approximately 70% of the 9.6 million deaths per year occurring in low- and middle-income countries (LMICs), where there is critical shortage of human and material resources or infrastructure to deal with cancer. If the current trend continues, the burden of cancer is expected to increase to 22 million new cases annually by 2030, with 81% of new cases and almost 88% of mortality occurring in LMICs. Global health places a priority on improving health and reducing these disparities to achieve equity in health for all people worldwide. In today's hyper-connected world, information and communication technologies (ICTs) will increasingly play an integral role in global health. Here, we focus on how the use of health-related technology, specifically ICTs and artificial intelligence (AI), can help in closing the gap between high-income countries (HICs) and LMICs in cancer care, research, and education. Key examples are highlighted on the use of telemedicine and tumor boards, as well as other online resources that can be leveraged to advance global health.
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Affiliation(s)
- Wilfred Ngwa
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Ian Olver
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Kathleen M Schmeler
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
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12
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Abdel-Wahab M, Rosenblatt E, Prajogi B, Zubizarretta E, Mikhail M. Opportunities in Telemedicine, Lessons Learned After COVID-19 and the Way Into the Future. Int J Radiat Oncol Biol Phys 2020; 108:438-443. [PMID: 32890528 PMCID: PMC7462967 DOI: 10.1016/j.ijrobp.2020.07.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 07/06/2020] [Indexed: 02/08/2023]
Affiliation(s)
- May Abdel-Wahab
- Telemedicine, Radiation Oncology, International Atomic Energy Agency, Vienna, Austria.
| | - Eduardo Rosenblatt
- Telemedicine, Radiation Oncology, International Atomic Energy Agency, Vienna, Austria
| | - Ben Prajogi
- Telemedicine, Radiation Oncology, International Atomic Energy Agency, Vienna, Austria
| | - Eduardo Zubizarretta
- Telemedicine, Radiation Oncology, International Atomic Energy Agency, Vienna, Austria
| | - Miriam Mikhail
- Telemedicine, Radiation Oncology, International Atomic Energy Agency, Vienna, Austria
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13
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Datta NR, Rogers S, Bodis S. Challenges and Opportunities to Realize “The 2030 Agenda for Sustainable Development” by the United Nations: Implications for Radiation Therapy Infrastructure in Low- and Middle-Income Countries. Int J Radiat Oncol Biol Phys 2019; 105:918-933. [DOI: 10.1016/j.ijrobp.2019.04.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 04/03/2019] [Accepted: 04/27/2019] [Indexed: 12/27/2022]
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Elmore SNC, Grover S, Bourque JM, Chopra S, Nyakabau AM, Ntizimira C, Krakauer EL, Balboni TA, Gospodarowicz MK, Rodin D. Global palliative radiotherapy: a framework to improve access in resource-constrained settings. ANNALS OF PALLIATIVE MEDICINE 2019; 8:274-284. [PMID: 30823841 DOI: 10.21037/apm.2019.02.02] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 02/13/2019] [Indexed: 12/18/2022]
Abstract
Radiotherapy is an essential component of cancer therapy. Lack of access to radiotherapy in less-developed countries prevents its use for both cure and symptom relief, resulting in a significant disparity in patient suffering. Several recent initiatives have highlighted the need for expanded access to both palliative medicine and radiotherapy globally. Yet, these efforts have remained largely independent, without attention to overlap and integration. This review provides an update on the progress toward global palliative radiotherapy access and proposes a strategic framework to address further scale-up. Synergies between radiotherapy, palliative medicine, and other global health initiatives will be essential in bringing palliative radiotherapy to patients around the globe.
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Affiliation(s)
- Shekinah N C Elmore
- Harvard Radiation Oncology Program, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
| | - Surbhi Grover
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, USA; Botswana-UPENN Partnership, University of Botswana, Gaborone, Botswana
| | - Jean-Marc Bourque
- Division of Radiation Oncology, The Ottawa Hospital and the University of Ottawa, Ontario, Canada; Institute of Cancer Policy, Kings College London, Guy's Hospital, London, UK
| | - Supriya Chopra
- Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India
| | - Anna Mary Nyakabau
- Ministry of Health and Child Welfare, Parirenyatwa Group of Hospitals, Harare, Zimbabwe; CancerServe Trust, Harare, Zimbabwe
| | - Christian Ntizimira
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Eric L Krakauer
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA; Global Palliative Care Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Tracy A Balboni
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts, USA; 13Department of Radiation Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Mary K Gospodarowicz
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario,Canada; Department of Radiation Oncology, University of Toronto, Ontario, Canada
| | - Danielle Rodin
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario,Canada; Department of Radiation Oncology, University of Toronto, Ontario, Canada
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Morgan GW, Foster K, Healy B, Opie C, Huynh V. Improving Health and Cancer Services in Low-Resource Countries to Attain the Sustainable Development Goals Target 3.4 for Noncommunicable Diseases. J Glob Oncol 2018; 4:1-11. [PMID: 30582432 PMCID: PMC7010423 DOI: 10.1200/jgo.18.00185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The United Nations Sustainable Development Goals 2015 to 2030 includes a specific goal for health (Sustainable Development Goal [SDG] 3) with 13 targets, including SDG3.4 for the control and treatment of noncommunicable diseases (NCDs), namely, cardiovascular diseases, cancer, diabetes, and chronic lung disease. There is considerable concern that SDG3.4 may not be achieved. The WHO Best Buys for NCDs has emphasized prevention, and although crucial, it alone will not achieve the 30% reduction in NCDs by 2030. Likewise, a strengthened health system is required as all NCDs are likely to require hospital facilities and community services for optimal management. This is a major problem for low-resource countries (LRCs) -that is, low-income countries and lower-middle-income countries-as most currently have a poorly developed health system, including cancer services, in need of upgrading. This is a result of the extreme poverty of LRCs, where 40% to 80% of the population live on less than USD $1.25 per day, with the average health spending by governments in low-income countries at $110 per person per year. In this article, we outline a comprehensive national cancer services plan for LRCs. Surgery, radiotherapy, and chemotherapy for cancer treatment also require input from other specialties, such as anesthesia, pathology, laboratory medicine, a blood bank, and diagnostic radiology. This will provide a focus for adding additional specialties, including cardiology, respiratory medicine, and psychiatry, to support the management of all NCDs and to contribute to the overall strengthening of the health system. The national cancer services plan for LRCs will require significant funding and input from both in-country and overseas experts in health, cancer, and finance working collaboratively. Success will depend on thoughtful strategic planning and providing the right balance of overseas support and guidance, but ensuring that there is in-country ownership and control of the program is essential.
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Affiliation(s)
- Graeme W Morgan
- Graeme W. Morgan, Kirsty Foster, and Vu Huynh, The University of Sydney; Craig Opie, Royal North Shore Hospital, Sydney, New South Wales; and Brendan Healy, Icon Cancer Group, Brisbane, Queensland, Australia
| | - Kirsty Foster
- Graeme W. Morgan, Kirsty Foster, and Vu Huynh, The University of Sydney; Craig Opie, Royal North Shore Hospital, Sydney, New South Wales; and Brendan Healy, Icon Cancer Group, Brisbane, Queensland, Australia
| | - Brendan Healy
- Graeme W. Morgan, Kirsty Foster, and Vu Huynh, The University of Sydney; Craig Opie, Royal North Shore Hospital, Sydney, New South Wales; and Brendan Healy, Icon Cancer Group, Brisbane, Queensland, Australia
| | - Craig Opie
- Graeme W. Morgan, Kirsty Foster, and Vu Huynh, The University of Sydney; Craig Opie, Royal North Shore Hospital, Sydney, New South Wales; and Brendan Healy, Icon Cancer Group, Brisbane, Queensland, Australia
| | - Vu Huynh
- Graeme W. Morgan, Kirsty Foster, and Vu Huynh, The University of Sydney; Craig Opie, Royal North Shore Hospital, Sydney, New South Wales; and Brendan Healy, Icon Cancer Group, Brisbane, Queensland, Australia
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16
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Potential Role of the Quality Assurance Review Center Platform in Global Radiation Oncology. Int J Radiat Oncol Biol Phys 2018; 99:956-962. [PMID: 29063855 DOI: 10.1016/j.ijrobp.2017.06.2461] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 06/14/2017] [Accepted: 06/22/2017] [Indexed: 11/22/2022]
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Bashshur RL, Krupinski EA, Thrall JH, Bashshur N. The Empirical Foundations of Teleradiology and Related Applications: A Review of the Evidence. Telemed J E Health 2016; 22:868-898. [PMID: 27585301 PMCID: PMC5107673 DOI: 10.1089/tmj.2016.0149] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 07/10/2016] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Radiology was founded on a technological discovery by Wilhelm Roentgen in 1895. Teleradiology also had its roots in technology dating back to 1947 with the successful transmission of radiographic images through telephone lines. Diagnostic radiology has become the eye of medicine in terms of diagnosing and treating injury and disease. This article documents the empirical foundations of teleradiology. METHODS A selective review of the credible literature during the past decade (2005-2015) was conducted, using robust research design and adequate sample size as criteria for inclusion. FINDINGS The evidence regarding feasibility of teleradiology and related information technology applications has been well documented for several decades. The majority of studies focused on intermediate outcomes, as indicated by comparability between teleradiology and conventional radiology. A consistent trend of concordance between the two modalities was observed in terms of diagnostic accuracy and reliability. Additional benefits include reductions in patient transfer, rehospitalization, and length of stay.
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Affiliation(s)
| | | | - James H. Thrall
- Department of Radiology, Massachusetts General Hospital, Harvard, Boston, Massachusetts
| | - Noura Bashshur
- University of Michigan Health System, Ann Arbor, Michigan
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18
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Abstract
Cancer is now recognized as one of the four leading causes of morbidity and mortality worldwide, and incidence is expected to rise significantly in the next two decades. Unfortunately, low- and middle-income countries (LMIC) suffer disproportionately from the world's cancer cases. The growing burden of cancer and maldistribution of cancer care resources in LMIC warrant a massive re-evaluation of the structural inequalities that produce global oncological disparities and a worldwide commitment to improve both prevention and treatment strategies. Efforts to improve cancer care capacity should focus on horizontal strengthening of healthcare systems that provide safe, affordable, effective and sustainable care. In response to current deficiencies, many international organizations have started to partner with LMIC to create solutions. Telemedicine and international collaboration are also promising ways to effect change and improve global oncological care.
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Affiliation(s)
- Madeline Pesec
- Brown University 6683, 69 Brown Street, Providence, RI 02912, USA
| | - Tracy Sherertz
- Department of Radiation Oncology, University of California, San Francisco, 1600 Divisadero St, Suite H-1031, San Francisco, CA 94115, USA
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19
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A Roadmap and Cost Implications of Establishing Comprehensive Cancer Care Using a Teleradiotherapy Network in a Group of Sub-Saharan African Countries With No Access to Radiation Therapy. Int J Radiat Oncol Biol Phys 2016; 95:1334-1343. [PMID: 27315665 DOI: 10.1016/j.ijrobp.2016.03.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 03/15/2016] [Accepted: 03/22/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE To propose a roadmap and explore the cost implications of establishing a teleradiotherapy network to provide comprehensive cancer care and capacity building in countries without access to radiation therapy. METHODS AND MATERIALS Ten low-income sub-Saharan countries with no current radiation therapy facilities were evaluated. A basic/secondary radiation therapy center (SRTC) with 2 teletherapy, 1 brachytherapy, 1 simulator, and a treatment planning facility was envisaged at a cost of 5 million US dollars (USD 5M). This could be networked with 1 to 4 primary radiation therapy centers (PRTC) with 1 teletherapy unit, each costing USD 2M. The numbers of PRTCs and SRTCs for each country were computed on the basis of cancer incidence, assuming that a PRTC and SRTC could respectively treat 450 and 900 patients annually. RESULTS An estimated 71,215 patients in these countries will need radiation therapy in 2020. Stepwise establishment of a network with 99 PRTCs and 28 SRTCs would result in 155 teletherapy units and 96% access to radiation therapy. A total of 310 radiation oncologists, 155 medical physicists, and 465 radiation therapy technologists would be needed. Capacity building could be undertaken through telementoring by networking to various international institutions and professional societies. Total infrastructure costs would be approximately USD 860.88M, only 0.94% of the average annual gross domestic product of these 10 countries. A total of 1.04 million patients could receive radiation therapy during the 15-year lifespan of a teletherapy unit for an investment of USD 826.69 per patient. For the entire population of 218.32 million, this equates to USD 4.11 per inhabitant. CONCLUSION A teleradiotherapy network could be a cost-contained innovative health care strategy to provide effective comprehensive cancer care through resource sharing and capacity building. The network could also be expanded to include other allied specialties. The proposal calls for active coordination between all national and international organizations backed up by strong geopolitical commitment and action from all stakeholders.
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Ngwa W, Ngoma T, Zietman A, Mayr N, Elzawawy A, Winningham TA, Balogun O, Enwerem-Bromson N, Ntizimira C, Olopade OI, Oluwole D, Odedina F, Williams M, Flanigan J, Asana L, Ngwa K, Avery S, Pollard JM, Roland T, Funwi-gabga N, Mbarika V, Hardenbergh P, Winkfield K, Pipman Y, Stefan C, Ngoma M, Mohammed S, Katz M, Erno S, Moni J, Fitzgerald T, Tonlaar N, Efstathiou J, Gierga D, Ayo C, Knaul F, Gospodarowicz M, Makrigiorgos GM, Nguyen PL. Closing the Cancer Divide Through Ubuntu: Information and Communication Technology-Powered Models for Global Radiation Oncology. Int J Radiat Oncol Biol Phys 2015; 94:440-9. [PMID: 26867873 DOI: 10.1016/j.ijrobp.2015.10.063] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 10/28/2015] [Accepted: 10/29/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Wilfred Ngwa
- Department of Radiation Oncology, Dana Farber Cancer Institute, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts; Department of Physics and Applied Physics, University of Massachusetts Lowell, Lowell, Massachusetts.
| | - Twalib Ngoma
- Department of Clinical Oncology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Anthony Zietman
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
| | - Nina Mayr
- Department of Radiation Oncology, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Ahmed Elzawawy
- African Organization for Research and Training in Cancer, Rondebosch, South Africa
| | | | - Onyinye Balogun
- Department of Radiation Oncology, Weill Cornell Medical College, New York
| | - Nelly Enwerem-Bromson
- Program of Action for Cancer Therapy, International Atomic Energy Agency, Vienna, Austria
| | | | | | | | - Folakemi Odedina
- African Organization for Research and Training in Cancer, Rondebosch, South Africa; College of Pharmacy, University of Florida, Gainesville, Florida
| | - Makeda Williams
- Center for Global Health, National Cancer Institute, Rockville, Maryland
| | - John Flanigan
- Center for Global Health, National Cancer Institute, Rockville, Maryland
| | - Lydia Asana
- African Renaissance Ambassador Corporation, Orlando, Florida
| | - Kenneth Ngwa
- African Renaissance Ambassador Corporation, Orlando, Florida
| | - Stephen Avery
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Julianne M Pollard
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Teboh Roland
- Department of Radiation Oncology, Johns Hopkins University, Baltimore, Maryland
| | - Neba Funwi-gabga
- Southern Alberta Institute of Technology, Calgary, Alberta, Canada
| | - Victor Mbarika
- Information and Communication Technology University, Baton Rouge, Louisiana
| | | | - Karen Winkfield
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
| | - Yakov Pipman
- International Educational Activities Committee, American Association of Physicists in Medicine, College Park, Maryland
| | - Christina Stefan
- African Organization for Research and Training in Cancer, Rondebosch, South Africa; South African Medical Research Council, Cape Town, South Africa
| | - Mamsau Ngoma
- Ocean Road Cancer Institute, Dar Es Salaam, Tanzania
| | - Sulma Mohammed
- Department of Comparative Pathobiology and Purdue University Center for Cancer Research, Purdue University, West Lafayette, Indiana
| | | | - Sajo Erno
- Department of Physics and Applied Physics, University of Massachusetts Lowell, Lowell, Massachusetts
| | - Janaki Moni
- Department of Radiation Oncology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Thomas Fitzgerald
- Department of Radiation Oncology, University of Massachusetts Medical School, Worcester, Massachusetts
| | | | - Jason Efstathiou
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
| | - David Gierga
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
| | | | - Felicia Knaul
- Harvard Global Equity Initiative, Harvard Medical School, Boston, Massachusetts
| | - Mary Gospodarowicz
- Princess Margaret Cancer Centre, 610 University Avenue, M5G 2M9, Toronto, ON, Canada; Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - G Mike Makrigiorgos
- Department of Radiation Oncology, Dana Farber Cancer Institute, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Paul L Nguyen
- Department of Radiation Oncology, Dana Farber Cancer Institute, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
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Grover S, Balogun OD, Yamoah K, Groen R, Shah M, Rodin D, Olson AC, Slone JS, Shulman LN, Coleman CN, Hahn SM. Training global oncologists: addressing the global cancer control problem. Front Oncol 2015; 5:80. [PMID: 25905040 PMCID: PMC4389376 DOI: 10.3389/fonc.2015.00080] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 03/17/2015] [Indexed: 12/04/2022] Open
Affiliation(s)
- Surbhi Grover
- Department of Radiation Oncology, University of Pennsylvania , Philadelphia, PA , USA
| | - Onyinye D Balogun
- Department of Radiation Oncology, New York University Perlmutter Cancer Center , New York, NY , USA
| | - Kosj Yamoah
- Department of Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University , Philadelphia, PA , USA
| | - Reinou Groen
- Department of Gynecology and Obstetrics, Johns Hopkins Hospital , Baltimore, MD , USA
| | - Mira Shah
- Department of Radiation Oncology, Henry Ford Health Systems , Detroit, MI , USA
| | - Danielle Rodin
- Department of Radiation Oncology, University of Toronto , Toronto, ON , Canada
| | - Adam C Olson
- Department of Radiation Oncology, Duke University Medical Center , Durham, NC , USA
| | - Jeremy S Slone
- Baylor College of Medicine, Texas Children's Hospital , Houston, TX , USA
| | - Lawrence N Shulman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School , Boston, MA , USA
| | - C Norman Coleman
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute , Bethesda, MD , USA ; International Cancer Expert Corps , Chevy Chase, MD , USA
| | - Stephen M Hahn
- Department of Radiation Oncology, University of Pennsylvania , Philadelphia, PA , USA
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