Clinical Oncology 26 (2014) 730e731 Contents lists available at ScienceDirect
Clinical Oncology journal homepage: www.clinicaloncologyonline.net
Letters
Could Clinical Oncology Training Address Manpower Issues in Low and Middle Income Countries? Sir d We read with interest the paper by Jeremic and colleagues [1] regarding access to radiotherapy in Africa. Of the 15 surveyed institutions, only one seems to employ ’clinical oncologists’, with the remainder having ’radiation oncologists’. Manpower shortages in low and middle income counties have resulted in inequities in health care access, long waiting times for diagnosis and treatment, and subsequent elevated health care costs for patients [2,3]. In these countries the disease burden, with increased rates of cervix and oesophageal cancers for example, is more heavily weighted towards those malignancies that can be managed with radiotherapy or chemoradiotherapy [4]. Having a single practitioner who can deliver systemic treatments in addition to radiotherapy would therefore seem to be advantageous. We would advocate encouraging a dual training approach that would reduce the number of clinicians an individual patient needs to see and allow a more flexible workforce. It would potentially assist in addressing the severe manpower issues many low and middle income countries face.
D.K. Woolf*, A. Aggarwaly * Mount Vernon Cancer Centre, Northwood, UK y Institute of Cancer Policy, Kings Health Partners Integrated Cancer Centre, Guy’s Hospital Campus, London, UK
References [1] Jeremic B, Vanderpuye V, Abdel-Wahab S, et al. Patterns of practice in palliative radiotherapy in Africa e case revisited. Clin Oncol (R Coll Radiol) 2014;26:333e343. [2] Barton MB, Frommer M, Shafiq J. Role of radiotherapy in cancer control in low-income and middle-income countries. Lancet Oncol 2006;7:584e595. [3] Pramesh CS, Badwe RA, Borthakur BB, et al. Delivery of affordable and equitable cancer care in India. Lancet Oncol 2014;15:e223ee233. [4] Bray F, Jemal A, Grey N, Ferlay J, Forman D. Global cancer transitions according to the Human Development Index (2008e2030): a population-based study. Lancet Oncol 2012;13:790e801.
http://dx.doi.org/10.1016/j.clon.2014.06.008 Ó 2014 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved
More Effort is Needed to Improve the Practice of Radiotherapy in Africa Sir d Jeremic et al. [1] presented an important follow-up to their previous survey carried out in 2008 about the pattern of practice of palliative radiotherapy in Africa [2]. Africa has great deficiencies in radiotherapy facilities. More importantly, these facilities have uneven distribution to the extent that in 2010 more than 59% of the African countries were totally deficient of any radiotherapy services [3]. The extent of the problem aggravates with the continuous increase in the population and cancer incidence. Furthermore, DOI of original article: http://dx.doi.org/10.1016/j.clon.2014.03.004.
0936-6555/
out of the 277 megavoltage machines existing in Africa, 168 (60%) are located in South Africa and Egypt. Moreover, most African radiotherapy centres are fairly basic, delivering simple treatment based on two-dimensional imaging and treatment planning. Fifty-six per cent of the centres operated with only one machine and only 18% were equipped with three-dimensional teletherapy machines [3]. Although Jeremic et al.’s [1] report did not include all centres surveyed in 2008 [2], it can still give an idea about progress in African radiotherapy facilities. The authors excluded the centres in South Africa, as they have resources
Clinical Oncology journal homepage: www.clinicaloncologyonline.net
Letters
Could Clinical Oncology Training Address Manpower Issues in Low and Middle Income Countries? Sir d We read with interest the paper by Jeremic and colleagues [1] regarding access to radiotherapy in Africa. Of the 15 surveyed institutions, only one seems to employ ’clinical oncologists’, with the remainder having ’radiation oncologists’. Manpower shortages in low and middle income counties have resulted in inequities in health care access, long waiting times for diagnosis and treatment, and subsequent elevated health care costs for patients [2,3]. In these countries the disease burden, with increased rates of cervix and oesophageal cancers for example, is more heavily weighted towards those malignancies that can be managed with radiotherapy or chemoradiotherapy [4]. Having a single practitioner who can deliver systemic treatments in addition to radiotherapy would therefore seem to be advantageous. We would advocate encouraging a dual training approach that would reduce the number of clinicians an individual patient needs to see and allow a more flexible workforce. It would potentially assist in addressing the severe manpower issues many low and middle income countries face.
D.K. Woolf*, A. Aggarwaly * Mount Vernon Cancer Centre, Northwood, UK y Institute of Cancer Policy, Kings Health Partners Integrated Cancer Centre, Guy’s Hospital Campus, London, UK
References [1] Jeremic B, Vanderpuye V, Abdel-Wahab S, et al. Patterns of practice in palliative radiotherapy in Africa e case revisited. Clin Oncol (R Coll Radiol) 2014;26:333e343. [2] Barton MB, Frommer M, Shafiq J. Role of radiotherapy in cancer control in low-income and middle-income countries. Lancet Oncol 2006;7:584e595. [3] Pramesh CS, Badwe RA, Borthakur BB, et al. Delivery of affordable and equitable cancer care in India. Lancet Oncol 2014;15:e223ee233. [4] Bray F, Jemal A, Grey N, Ferlay J, Forman D. Global cancer transitions according to the Human Development Index (2008e2030): a population-based study. Lancet Oncol 2012;13:790e801.
http://dx.doi.org/10.1016/j.clon.2014.06.008 Ó 2014 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved
More Effort is Needed to Improve the Practice of Radiotherapy in Africa Sir d Jeremic et al. [1] presented an important follow-up to their previous survey carried out in 2008 about the pattern of practice of palliative radiotherapy in Africa [2]. Africa has great deficiencies in radiotherapy facilities. More importantly, these facilities have uneven distribution to the extent that in 2010 more than 59% of the African countries were totally deficient of any radiotherapy services [3]. The extent of the problem aggravates with the continuous increase in the population and cancer incidence. Furthermore, DOI of original article: http://dx.doi.org/10.1016/j.clon.2014.03.004.
0936-6555/
out of the 277 megavoltage machines existing in Africa, 168 (60%) are located in South Africa and Egypt. Moreover, most African radiotherapy centres are fairly basic, delivering simple treatment based on two-dimensional imaging and treatment planning. Fifty-six per cent of the centres operated with only one machine and only 18% were equipped with three-dimensional teletherapy machines [3]. Although Jeremic et al.’s [1] report did not include all centres surveyed in 2008 [2], it can still give an idea about progress in African radiotherapy facilities. The authors excluded the centres in South Africa, as they have resources
