Tackling the global shortfall in radiotherapy could save millions of lives and boost the economy of poorer countries

Prof Rifat Atun - Harvard University, Boston, USA

You found a lack in radiotherapy facilities and treatment across the world. What were your objectives when looking at this?

So we had a multidisciplinary group of researchers from around the world to look at current coverage levels of radiotherapy in low, middle income and upper income countries. We looked at current levels against what they ought to be given the disease burden. We were very surprised with the findings. While there are huge deficiencies in low income countries and even middle income countries such as Brazil and China where the coverage levels are 50% of what they ought to be, in sub-Saharan Africa there are many countries with no radiotherapy facilities at all. But even in upper income countries such as Western Europe there is only one country, the Netherlands, which has reached full coverage levels.

That’s a bit disturbing. What are the consequences?

People are dying needlessly of course. Radiotherapy is highly effective, it provides local control as well as improved survival for the individuals treated. Many, almost 50% of cancers can be addressed by radiotherapy. What we set out to do was to demonstrate a) that scaling up radiotherapy is feasible and possible and b) that there are health and economic benefits.

You have been looking at 2015 to 2035, projecting through the future. What facts have you discovered?

I think the unique feature of the study is that it’s truly global. We looked at all countries in the world and we looked over the period 2015 to 2035. We looked at coverage levels in each country then we costed what it would take to scale up over a period of twenty years, so by 2035 full coverage was achieved. So we computed the costs and then we looked at, we modelled, what the health benefits would be and we were able to identify that the health benefits would be 26.9 million life years saved as a result of scaling up.

There are big health benefits, but what about the impact on the economy?

Absolutely, and that’s a critical finding of the study, that beyond the health benefits that are, of course, very important, as individuals live longer and as they become productive they generate economic activity and benefits. The economic benefits outweigh the costs in low and middle income countries, including upper middle income countries and the numbers are very large. While it would cost $184 billion to scale up over twenty years in the low and middle income countries, the benefits are far larger. In fact, in the upper middle income countries for each dollar invested we get $6 in return.

What should cancer doctors, members of the public and politicians be urging to do right now?

There’s a compelling case for investing in radiotherapy – it’s effective, it’s safe, it’s feasible to scale up, it brings health benefits but it also brings economic benefits to the countries as well as the social benefits from the suffering and the pain that can be alleviated in people who have terminal cancer. So one should make a case of decision-makers, particularly, not just Ministers of Health but the Ministers of Finance to the parliamentarians and mobilise civil society and those affected by cancer to ensure that investments are made for the new technologies that are currently available.

Is there a belief that it is not possible to scale up radiotherapy in low and middle income countries?

Absolutely and that’s a myth. Absolutely. We are able to demonstrate through case studies that even in very low resource settings one is able to scale up high quality radiotherapy services. So the scale up is feasible, possible, it can be done consistently and it can provide highly effective and quality care.

Is there a trade-off between that and getting better diagnostic and medicine treatment of cancer?

There are no trade-offs. I think any cancer control programme must include four components: one, radiotherapy, two, surgery, three, clinical oncology with therapeutic medicine interventions underpinned by strong health systems. The moment is right because universal health coverage aimed at the strengthening health systems is one of the goals of the sustainable development goals. So this is the time to act.