Access to diagnostic imaging and radiotherapy technologies for patients with cancer in the Baltic countries, eastern Europe, central Asia, and the Caucasus: a comprehensive analysis
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October 17, 2024
The Lancet Oncology journal has published a new study identifying disparities in diagnostic imaging and radiotherapy technologies (RT) access in the region comprised of twelve former Soviet Union countries. The ART (Access to Radiotherapy Technologies) Study addressed gaps in access in the Baltics, Eastern Europe, Central Asia, and the Caucasus. By addressing these notable gaps, healthcare services can enhance their capacity to rapidly diagnose and effectively treat cancer patients, ultimately improving survival rates.
The study, conducted by ICEC in collaboration with Oxford University, included participation from global experts from the following institutions and organizations:
- International Cancer Expert Corps (ICEC)
- Oxford University, UK
- International Atomic Energy Agency (IAEA), Austria
- King Hussein Cancer Center, Jordan
- University of Abuja, Nigeria
- Cyril and Methodius University, North Macedonia
- Swansea University and Medical School, UK
Participating countries included Armenia, Azerbaijan, Estonia, Georgia, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Moldova, Tajikistan, Ukraine, and Uzbekistan.
“Having treated cancer patients with linear accelerators but also with cobalt-60 machines, I can appreciate the significant technical advantages of a linac that will be available for these radiation oncologists to treat their patients. The challenges they face are daunting but can be overcome with adequate financial, education and training resources as evidenced by the Baltic countries.” – Dr. David Pistenmaa, ICEC Chief Scientific Program Advisor
The study analyzed national cancer data, surveys, and granular input from regional cancer specialists and regulators. Key areas evaluated included staff capacity, imaging and radiation therapy technology availability, radiation safety, and training opportunities. The countries studied differed statistically in population, GDP per capita, cancer incidence, and cancer mortality rates. Though data reflected lower reported cancer incidence rates in countries such as Kazakhstan, Azerbaijan, Uzbekistan, Kyrgyzstan, and Tajikistan, this is likely due to insufficient numbers of diagnostic imaging equipment.
The research highlights the challenges faced in low- and middle-income countries (LMICs) and illustrates how additional funding and investment could enhance the delivery of Radiation Therapy (RT) and cancer-related services to improve treatment outcomes. The graphic below depicts the availability of external beam radiation therapy (EBRT) machines and oncologists in the region using average values shown as red dots. This region has the the second-highest reliance on cobalt-60 EBRT machines for cancer treatment—second only to Sub-Saharan Africa. The ART Study and related workshops aimed to gather critical data to identify and address obstacles in making the transition from cobalt-60 machines to linear accelerators (linacs) to treat patients with cancer.
More economically developed countries, such as Estonia, Latvia, and Lithuania, showed greater diagnostic imaging and radiotherapy capacity and enhanced radiation oncology resources, leading to better survival rates than the average for the ART countries. The Baltic countries showed above average EBRT capacity and numbers of oncologists, while Georgia also demonstrated elevated EBRT capacity. Kazakhstan and Ukraine also had a higher number of oncologists. Other participating countries had lower radiotherapy equipment and staffing levels.
Notably, there was no consistent correlation between increased equipment capacity and greater survival rates, as countries with the lowest GDPs and EBRT capacities reported the lowest cancer death rates. The lack of diagnostic imaging equipment in these countries contributes to many cancer patients going undiagnosed. In contrast, those with the highest GDPs and EBRT capacities showed the highest death rates and most favorable cancer death-to-incidence ratios (MIRs).
“Improving cancer survival in Baltic countries requires a multifaceted approach that builds human and technical capacity, enhances cancer detection rates, and improves access to quality cancer care. Due to significant resource disparities, each country must create a tailored roadmap to enhance its cancer program.” – Prof. Manjit Dosanjh, Lead researcher (University of Oxford Department of Physics)
The results indicate a critical need for enhanced education and training opportunities to deliver RT across all countries, and more medical physicists, radiation therapy technologists, and engineers are needed to maintain radiation therapy equipment across the region.
“Increasing access to state-of-the-art radiotherapy technologies is critical to improving cancer care across the countries studied. With participating countries having differing population needs, varying cancer burdens, limited workforces and financial resources, this unique study provided an opportunity to understand better the many challenges faced in transitioning from co-60 machines to more advanced linear accelerators. This effort also provided the opportunity to identify regional and international education and training resources to help support the transition from older to newer, sophisticated technologies.” – Eugenia Wendling, Executive Director, ICEC
“You managed to unite us all in one paper. This is [an] unbelievably tremendous job.” – Gulam Babayev, Azerbaijan Regional Office of Science and Technology Center Ukraine (STCU), Baku, Azerbaijan
Media Contact:
Sierra Kelleher, ICEC
sierra.kelleher@iceccancer.org