Establishing and Delivering Quality Radiation Therapy in Resource-Constrained Settings: The Story of Botswana

被引:34
作者
Efstathiou, Jason A. [1 ]
Heunis, Magda [3 ,4 ]
Karumekayi, Talkmore [5 ]
Makufa, Remigio [5 ]
Bvochora-Nsingo, Memory [5 ]
Gierga, David P. [1 ]
Suneja, Gita [9 ]
Grover, Surbhi [10 ]
Kasese, Joseph [6 ]
Mmalane, Mompati [7 ]
Moffat, Howard [8 ]
von Paleske, Alexander [11 ]
Makhema, Joseph [7 ]
Dryden-Peterson, Scott [2 ,7 ]
机构
[1] Harvard Univ, Massachusetts Gen Hosp, Sch Med, Boston, MA USA
[2] Brigham & Womens Hosp, 75 Francis St, Boston, MA 02115 USA
[3] Univ Stellenbosch, Cape Town, South Africa
[4] Tygerberg Hosp, Cape Town, South Africa
[5] Gaborone Private Hosp, Gaborone, Botswana
[6] Bokamoso Private Hosp, Gaborone, Botswana
[7] Botswana Harvard AIDS Inst, Gaborone, Botswana
[8] Botswana Minist Hlth, Gaborone, Botswana
[9] Univ Utah, Sch Med, Huntsman Canc Hosp, Salt Lake City, UT USA
[10] Univ Penn, Perelman Sch Med, Philadelphia, PA 19104 USA
[11] Univ Zimbabwe, Mpilo Hosp, Bulawayo, Zimbabwe
关键词
MIDDLE-INCOME COUNTRIES; GLOBAL ACCESS; RADIOTHERAPY; CANCER; ONCOLOGY; BRACHYTHERAPY; INFRASTRUCTURE; IMPLEMENTATION; GUIDELINES; CARCINOMA;
D O I
10.1200/JCO.2015.62.8412
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
There is a global cancer crisis, and it is disproportionately affecting resource-constrained settings, especially in low- and middle-income countries (LMICs). Radiotherapy is a critical and cost-effective component of a comprehensive cancer control plan that offers the potential for cure, control, and palliation of disease in greater than 50% of patients with cancer. Globally, LMICs do not have adequate access to quality radiation therapy and this gap is particularly pronounced in sub-Saharan Africa. Although there are numerous challenges in implementing a radiation therapy program in a low-resource setting, providing more equitable global access to radiotherapy is a responsibility and investment worth prioritizing. We outline a systems approach and a series of key questions to direct strategy toward establishing quality radiation services in LMICs, and highlight the story of private-public investment in Botswana from the late 1990s to the present. After assessing the need and defining the value of radiation, we explore core investments required, barriers that need to be overcome, and assets that can be leveraged to establish a radiation program. Considerations addressed include infrastructure; machine choice; quality assurance and patient safety; acquisition, development, and retention of human capital; governmental engagement; public-private partnerships; international collaborations; and the need to critically evaluate the program to foster further growth and sustainability. (C) 2015 by American Society of Clinical Oncology
引用
收藏
页码:27 / +
页数:10
相关论文
共 47 条
  • [41] Overview of national guidelines for infrastructure and staffing of radiotherapy. ESTRO-QUARTS: Work package 1
    Slotman, BJ
    Cottier, B
    Bentzen, SM
    Heeren, G
    Lievens, Y
    van den Bogaert, W
    [J]. RADIOTHERAPY AND ONCOLOGY, 2005, 75 (03) : 349 - 354
  • [42] Cancer in Botswana: resources and opportunities
    Suneja, Gita
    Ramogola-Masire, Doreen
    Medhin, Heluf G.
    Dryden-Peterson, Scott
    Bekelman, Justin E.
    [J]. LANCET ONCOLOGY, 2013, 14 (08) : E290 - E291
  • [43] Van Dyk J., 1996, Current Oncology, V3, P8
  • [44] American Brachytherapy Society consensus guidelines for locally advanced carcinoma of the cervix. Part II: High-dose-rate brachytherapy
    Viswanathan, Akila N.
    Beriwal, Sushil
    De Los Santos, Jennifer F.
    Demanes, D. Jeffrey
    Gaffney, David
    Hansen, Jorgen
    Jones, Ellen
    Kirisits, Christian
    Thomadsen, Bruce
    Erickson, Beth
    [J]. BRACHYTHERAPY, 2012, 11 (01) : 47 - 52
  • [45] Zietman AL, SAFETY IS NO ACCIDEN
  • [46] Bringing Radiation Therapy to Underserved Nations: An Increasingly Global Responsibility in an Ever-Shrinking World
    Zietman, Anthony
    [J]. INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 2014, 89 (03): : 440 - 442
  • [47] Need for Radiotherapy in Low and Middle Income Countries - The Silent Crisis Continues
    Zubizarreta, E. H.
    Fidarova, E.
    Healy, B.
    Rosenblatt, E.
    [J]. CLINICAL ONCOLOGY, 2015, 27 (02) : 107 - 114