5 ways to close the ‘unacceptable gap’ in cancer care between developed, developing nations

Filling the noticeable gap in quality cancer care between high- and low-income countries is a daunting task, but one that’s worth the effort, a group of experts recently reported in Radiotherapy and Oncology.

C. Norman Coleman, MD, the corresponding author of the piece, wrote that closing the “unacceptable gap” requires not only collaboration among medical professionals, but also a shift in the way we think about third-world issues. 

“Filling the gap in cancer care in underserved regions worldwide requires global collaboration and concerted effort to share creative ideas, pool talents and develop sustainable support from governments, industry, academia and non-governmental organizations,” Coleman and his co-authors said.

To meet the radiotherapy demands in low- and middle-income countries in 2035, the authors said, it’s projected the industry will need 30,000 more radiation oncologists, 12,600 megavoltage treatment machines and nearly 80,000 radiation technologists. 

How do well-off physicians help the effort? The authors suggest they start here:

1. Recognize a region’s local healthcare champions.

Physicians who practice in countries with rich healthcare systems shouldn’t assume that, say, a Sub-Saharan African practice will be dirty or out-of-date, Coleman et al. wrote. Rather than assuming a country suffers from poor medical leadership or outdated education, the authors suggested letting local figures—not outside volunteers—head improvement efforts.

“Top-down solutions from upper-income countries contain useful tools and frameworks, but the needs, solutions and timetables should be driven by specialists in local communities and external experts who best understand the issues,” they said.

It’s important to look at these lower-income health systems as independent drivers of their own programs with outside input, Coleman and co-authors said, instead of assuming a country’s practices will be “second-rate.”

2. Think twice before donating equipment overseas.

Purchasing or donating used radiology equipment to countries hurting for funds isn’t a bad idea, the authors wrote, but anyone looking to do that should do their homework. 

Donated machines can be of great use to a lower-income country, especially one low on radiology equipment and staff, but it’ll result in wasted money or incorrectly used technology if healthcare providers on the receiving end aren’t well-versed in the tech itself.

3. Invest in research in low- and middle-income countries.

Outside opinions can be invaluable to countries where practices and individual physicians are grasping for expert input, but Coleman et al. said it’s also important to cultivate learning within a community. Nobody will understand the demographics, norms and customs of a region like its residents, so the authors suggested donating to research programs like population studies to define what the cancer problem looks like in specific areas. 

Other research also needs to be expanded, they said, like biology and epidemiology investigations to understand how the environment and microbiome affect cancer rates, cancer treatment outcomes studies, economic analyses and policy projects.

4. Take advantage of teleconferencing.

Interactive teleconferencing supports case-based, peer-supported learning within medical communities, Coleman and colleagues wrote. Connection with outside specialists can be instantaneous and improve quality of care. Teleconferencing itself is considered “critical to education and mentorship” in countries where radiologists are scarce.

5. Consider money-savvy alternatives to using harmful radiation techniques.

Radioactive isotopes like cobalt-60 are used often in low- and middle-income countries, the authors explained, because related therapies have shown some success and the isotopes themselves are on the cheaper side. But the high risk of harm might outweigh potential benefits.

“The Office of Radiological Security of the U.S. [National Nuclear Security Administration] stressed the risk posed by malicious use of high-activity radiological sources, and the potential for linacs to permanently reduce these radiological security risks by providing high-quality treatment without the use of cobalt-60,” Coleman et al. said. “For hospitals that utilize cobalt-60 teletherapy machines, ORS emphasized the need to protect the radioactive sources from unauthorized access.”