As the world has been consumed with the global COVID-19 pandemic, another disease continued to devastate lives and livelihoods around the globe. At least 3 million lives were lost to COVID-19 in 2020, spurring unprecedented investment in scientific research and healthcare infrastructure focused on addressing and containing this global pandemic.1 Yet, in 2020, nearly 10 million lives were lost due to cancer, a disease so prevalent and longstanding that it is neither an epidemic nor a pandemic. As a disease found in every community on every continent, and is expected to grow in years to come, cancer is globally endemic — seemingly entrenched for the foreseeable future. Despite billions of dollars invested by governments, industry and academic organizations, cancer remains a global threat: The first or second leading cause of death in 61 percent of countries in 2019, the cause of nearly 10 million deaths in 2020, and a growing threat with an incidence expected to increase 47 percent by 2040.2
Although there are key differences between a pandemic resulting from a contagious disease and one that has genetic, environmental and other multifactorial causes, the threats posed by COVID-19 and cancer highlight long-standing and global inequities in access to healthcare and potentially lifesaving technologies. Many reports in popular media and medical journals focus on inequities in access to COVID-19 testing, vaccines and therapeutics, as well as disparities in healthcare infrastructure, hospital resources and financial coverage of COVID-19 related care. The inequities and disparities in cancer care are no less stark, even if they garner less ongoing coverage in most people’s daily news feeds.
For example, while radiation therapy will be needed by 50-60 percent of all cancer patients,3 many patients today lack access to this pillar of cancer treatment. Given the significant financial barriers that may inhibit access to all manner of healthcare, it is perhaps not surprising that low- and middle-income countries have 80 percent of the global cancer burden, but have access to only 32 percent of global radiation therapy resources.3 Unsurprising, yet still deeply alarming. Similarly, while the median density of radiotherapy delivery systems per million people is 5.1 in high-income countries (range 0.4-11.6), it is 0 in low-income countries (0-0.4).4 While these statistics are disturbing, of even greater concern is the estimate that, on the current trajectory, access to radiation therapy may be further reduced as the growth in the number of cancer patients outpaces the growth of available resources, especially in sub-Saharan Africa and parts of Asia.5
Effectively addressing the growing global cancer threat requires new approaches that address inequities in access to safe and effective healthcare. This includes expanding access to radiation therapy for patients needing treatment today and establishing global infrastructure for ensuring sufficient radiation therapy resources to meet future demand for treatment regardless of where patients live.
Looking Beyond Product Approval
Radiation therapy device manufacturers have a critical role to play in developing and implementing scalable and sustainable approaches to increasing global access to radiation therapy. While device approval may, on its surface, appear to be the end goal of innovating novel systems for radiation therapy, it is really only a point of interest in a longer journey toward improving patient care and outcomes. Addressing entrenched, global healthcare inequities will require intensive collaboration among national and regional governments, non-governmental organizations, the medical community, economists, educational systems and patient advocates. Yet, given the foundational role that radiation therapy plays across diverse cancer indications, manufacturers of radiation therapy systems cannot stand on the sidelines and wait for change on a global or even national level. They must act today and, fortunately, there are multiple ways in which they can contribute to improving access to a pillar of cancer care.
Leverage Innovation Expertise to Solve Real-world Challenges
One way is to develop radiation therapy delivery devices that are safe and effective, but operate efficiently in smaller care centers and resource-constrained settings. This type of product development should be done collaboratively with customers in order to design systems that meet their actual needs and constraints, and can readily be implemented in the context of existing clinical practices and workflows. Device standardization and interoperability are also important for increasing flexibility, resilience and efficiency in delivering radiation therapy services worldwide.6 Innovations that cannot be integrated with a center’s exiting radiation therapy are unlikely to yield the patient benefits they were designed to provide.
Help Train the Personnel Who are Essential for Realizing the Benefits of Radiation Therapy
Beyond developing and manufacturing radiation therapy systems, device manufacturers have an important role to play in providing education that allows their systems to be used safely, effectively and efficiently. A shortage of radiation therapy professionals is a key limitation to expanding access to care. A recent study by the Federation of Asian Organizations for Radiation Oncology found that only 54 percent of Asia’s need for radiation oncologists has been met and that member countries are producing fewer than 10 new radiation oncologists every year.
Device manufacturers can help to address this shortage by taking existing technologies and training programs to in-need areas of the world and by developing new training programs tailored to the personnel and resources that are typically available in resource-constrained settings. Such training will be essential to realizing the benefits that newer, more precise and personalized radiation therapy systems may provide.
In addition to their own programs, I believe device manufacturers should prioritize collaborating with other stakeholders to support the initial training or continuing education of radiation oncologists, radiation therapists and medical physicists.4 For example, the American Society of Radiologic Technologists has a foundation that has partnered with device manufacturers to provide scholarships for students wishing to pursue careers as radiation therapists. Device manufacturers may also consider partnering with local philanthropic or educational organizations to establish or support grant programs that address the shortage of radiation therapy personnel.
Support Educational Outreach and Increased Funding
Partnering with advocacy groups, policy makers, industry and academia to improve educational outreach and increase funding for radiation therapy is another way in which device manufacturers can help to improve outcomes for cancer patients. One approach to achieving this goal is collaborating with existing national and global organizations focused on increasing access to radiotherapy. This includes engaging with national governments’ policy makers to establish more relevant reimbursement models that recognize the health and economic value that radiation therapy provides. Supporting groups that lobby governments to increase funding for high-precision radiotherapy, such as Radiotherapy4Life and its #CatchUpWithCancer campaign, may help to ensure adequate access to these therapies for all patients who need them and reduce the backlog of cancer patients due to the pandemic. Similarly, device manufacturers may wish to explore participating in organizations that advocate for radiotherapy at a political, policy, industry, scientific, patient and national cancer plan level, such as the Global Coalition for Radiotherapy. They also may identify opportunities to support existing programs or initiate additional programs organized by the International Atomic Energy Agency, which provides guidelines and procurement support for new and established radiation therapy centers and also manages the only global database on radiation therapy resources.
Put Your Money Where Your Mission Is
Finally, radiation therapy device manufacturers also have the ability — and perhaps the responsibility — to establish corporate philanthropy efforts that support projects and programs in partnership with governments, NGOs and healthcare providers in low- and middle-income countries to improve access to cancer care.
A silver lining of the COVID-19 pandemic is that it has demonstrated the power of collaboration, investment and focus to protect and improve human health and to give hope that we can solve seemingly intractable health challenges. It has been refreshing to see much of the collaboration on COVID-19 vaccines and therapies driven by academic and industry scientists. As individual companies seek their own solutions for the ongoing challenges of cancer, innovators of novel radiation therapy technologies have diverse opportunities to harness the spirit of the moment and to play a defining role in the collaborative effort to address global inequities to accessing lifesaving therapy.
Gustaf Salford is president and chief executive officer of Elekta, where he took the helm in November 2020 in the height of the COVID-19 pandemic. A proven leader with international business acumen and intimate knowledge of the medical device industry, Salford has held senior management roles at the company for 12 years, including chief financial officer, head of group business control and business controller for Europe, Africa, Latin America and the
1. World Health Organization. The true death toll of COVID-19: Estimating global excess mortality. Available at: https://www.who.int/data/stories/the-true-death-toll-of-covid-19-estimating-global-excess-mortality. Accessed Sept. 30, 2021.
2. Sung H, Ferlay J, Siegel RL, Laversanne M et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71:209-249.
3. Atun R, Jaffray DA, Barton MB et al. Expanding global access to radiotherapy. Lancet Oncol. 2015;16:1153-86.
4. Abdel-Wahab M, Gondhowiardjo SS, Rosa AA et al. Global radiotherapy: Current status and directions – white paper. JCO Global Oncol. 2021;7:827-842.
5. Gospodarowicz M. Global access to radiotherapy – work in progress. JCO Global Oncol. 2021;7:144-145.
6. Abdel-Wahab M, Rengan R, Curran B et al. Integrating the healthcare enterprise in radiation oncology plug and play--the future of radiation oncology? Int J Radiat Oncol Biol Phys. 2010;76:333-336.
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