[PPT] - Radiotherapy in cancer Radiotherapy in cancer control in low PowerPoint Presentation

SLIDE 1

Radiotherapy in cancer Radiotherapy in cancer control in low control in low-

and

and middle middle income countries income countries middle middle-income countries income countries

SLIDE 2

XRT in LMI countries XRT in LMI countries XRT in LMI countries XRT in LMI countries

What is LMI?

Cancer in LMI

Need for XRT

Cost and cost

Cost and cost-

effectiveness

effectiveness

Current state of XRT in LMI countries

Case studies

Breast

Breast

Breast

Breast

Cervix

Cervix

Lung

Lung Lung Lung

SLIDE 3

LMI countries LMI countries LMI countries LMI countries

Income Income Gross National Income Gross National Income per person per year (US$) per person per year (US$) per person per year (US$) per person per year (US$) Low Low 765 765 Middle Middle 766 766 – – 9,385 9,385 High High 9,386 9,386

SLIDE 4

World Bank Incomes

Upper middle income (34) Lower middle income (54) ( ) Low income (60) High income: OECD (24) High income: nonOECD (26)

SLIDE 5

Cancer in LMI countries Cancer in LMI countries Cancer in LMI countries Cancer in LMI countries

10 illi b 2010 10 illi b 2010

10 million new cases by 2010

> 50% of all cancers occur in LMI

70% by 2020

SLIDE 6

New cases of cancer New cases of cancer

Globocan 2002

SLIDE 7

Radiotherapy Utilisation Radiotherapy Utilisation Radiotherapy Utilisation Radiotherapy Utilisation

52% of all cancer patients need

52% of all cancer patients need radiotherapy at least once radiotherapy at least once

86% curative or adjuvant

86% curative or adjuvant 86% cu at e o adju a t 86% cu at e o adju a t

20

20-

25% may need > 1 treatment episode

25% may need > 1 treatment episode

RTU likely to be higher

More advanced stage

More advanced stage

Less surgical expertise

Less surgical expertise g p g p

SLIDE 8

The need for radiotherapy The need for radiotherapy The need for radiotherapy The need for radiotherapy

Russia Latvia Iceland Estonia Canada Uzbekistan United States United Kingdom United Arab Emirates Ukraine Turkey Tunisia Tajikistan Syria Spain Slovenia Slovakia Serbia Saudi Arabia Romania Qatar Portugal Poland Pakistan Niger Myanmar Morocco Mongolia Moldova Mexico Malta Mali Macedonia Lithuania Libya Lebanon Latvia Kyrgyzstan Kuwait Korea Rep. Korea DPR Kazakhstan Jordan Japan Jamaica Ireland Iraq India Hungary Haiti Greece Germany Georgia France Egypt Dominican Republic Czech Republic Cyprus Cuba Croatia China Bulgaria Bosnia and Herzegovina Belarus Bangladesh Azerbaijan Armenia Algeria Albania Afghanistan Zimbabwe Zambia Yemen Vietnam Venezuela Uganda Thailand Tanzania Sudan Sri Lanka Singapore Sierra Leone Senegal Philippines Peru P Panama Nigeria g Nicaragua Namibia Mauritius Malaysia Malawi Madagascar Liberia Kenya Indonesia Honduras Guatemala Ghana Gabon Ethiopia Eritrea El Salvador Ecuador Democratic Republic of the Congo Cote D'Ivoire Costa Rica Chad Central African Republic Cape Verde Cameroon Burkina Faso Brazil Botswana Bolivia Benin Angola

% of cases requiring RT

Uruguay South Africa Paraguay Namibia Chile Australia Argentina

q g 0 - 0.39 0.39 - 0.43 0.43 - 0.47 0 47 - 0 51

N. Taylor, IAEA 2005

0.47 - 0.51 0.51 - 0.55 0.55 - 0.59 0.59 - 1

SLIDE 9

Cancer cases needing XRT Cancer cases needing XRT Cancer cases needing XRT Cancer cases needing XRT

Russia Iceland Canada Uzbekistan United States United Kingdom United Arab Emirates Ukraine Turkey Tunisia Tajikistan Syria Spain Slovenia Slovakia Serbia Saudi Arabia Romania Qatar Portugal Poland Pakistan Morocco Mongolia Moldova Mexico Malta Macedonia Lithuania Libya Lebanon Latvia Kyrgyzstan Kuwait Korea Rep. Korea DPR Kazakhstan Jordan Japan Ireland Iraq India Hungary Greece Germany Georgia France Estonia Egypt Czech Republic Cyprus Cuba Croatia China Bulgaria Bosnia and Herzegovina Belarus Bangladesh Azerbaijan Armenia Algeria Albania Afghanistan Zimbabwe Zambia Yemen Vietnam Venezuela Uganda Thailand Tanzania Sudan Sri Lanka Singapore Sierra Leone Senegal Philippines Peru Panama Nigeria Niger Nicaragua Myanmar Mali Malaysia Malawi Madagascar Liberia Kenya Jamaica Indonesia Honduras Haiti Guatemala Ghana Gabon Ethiopia Eritrea El Salvador Ecuador Dominican Republic Democratic Republic of the Congo Cote D'Ivoire Costa Rica Chad Central African Republic Cape Verde Cameroon Burkina Faso Brazil Bolivia Benin Angola

Cancer Cases per Million Population Requiring RT

bab e Uruguay South Africa Paraguay Namibia Mauritius Chile Botswana Australia Argentina

0 - 200 200 - 800 800 - 1200

N. Taylor, IAEA 2005

1200 - 1600 1600 - 2000 2000 - 20000

SLIDE 10

Cost Cost Cost Cost

Building Building 3% 3% Building Building 3% 3% Equipment Equipment 30% 30% Staff Staff 50% 50% Materials Materials 4% 4% Overheads Overheads 13% 13% Overheads Overheads 13% 13%

Kesteloot K, Lievens Y, van der SE. Improved management of radiotherapy departments through accurate cost data. Radiother Oncol 2000; 55(3):251-262.

SLIDE 11

C b lt C b lt Li Li Cobalt Cobalt Linac Linac Machine Machine $480,000 $480,000 $1,800,000 $1,800,000 Maintenance Maintenance $1270 to $1270 to $35,680 $35,680 $3000 to $3000 to $91,740 $91,740 Cost per Cost per treatment treatment $4.87 $4.87 $11 $11

Van Der Giessen PH, Alert J, Badri C, Bistrovic M, Deshpande D, Kardamakis D et al. Multinational assessment of some operational costs of teletherapy. Radiother Oncol. 2004;71(3):347-55.

SLIDE 12

Current status of XRT Current status of XRT Current status of XRT Current status of XRT

24/ 72 countries with > 1 million

24/ 72 countries with > 1 million people had no XRT people had no XRT

Average GNI/ cap US$300

Average GNI/ cap US$300 e age G / cap US$300 e age G / cap US$300

All Member States

100.000 Europe 10.000 S$ 1,000s Asia & Pacific Central America South America Africa straight line fit 0.100 1.000 0.0100 0.1000 1.0000 10.0000 100.0000 GDP/capita US 0.010

No. teletherapy units / million population

SLIDE 13

Cervix Cervix Cervix Cervix

> 80% new cases & deaths

> 80% new cases & deaths in LMI in LMI in LMI in LMI

50

50-

60% of new cases die of

60% of new cases die of cervix cancer cervix cancer

100 1 0

Incidence Mortality M/I ratio

91

91-

99% need XRT

99% need XRT

60 80 100

d) rate per 100, 000

0.6 0.8 1.0

ence ratio*

20 40

standerdised (world

0.2 0.4

Mortality/Incide high income countries upper-middle income countries low-middle income countries low income countries

Age s

0.0

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Strategies to improve access Strategies to improve access Strategies to improve access Strategies to improve access

Planning

Investment

Investment Li k Li k

Linkages

Access to information

Education about cancer

Safety

SLIDE 15

Planning Planning Planning Planning

No “one size fit’s all” plan

No one size fit s all plan

casemix

casemix

capabilities

capabilities

100%

Liver Ovary etc.

capabilities

capabilities

70% 80% 90%

Leukaemia Thyroid Testis Multiple myeloma Melanoma of skin Kidney etc.

40% 50% 60%

Corpus uteri Other Pharynx Pancreas Hodgkin's disease Colon/Rectum Brain, nervous system

20% 30%

Nasopharynx Larynx Oral cavity Lung Stomach Bladder N H d ki l h

0% 10% East Africa Central Africa Northern Africa Southern Africa Western Africa all Africa

Non-Hodgkin lymphoma Oesophagus Prostate Cervix uteri Breast

SLIDE 16

Investment Investment Investment Investment

Equipment

Staff

Maintenance

Source

Source replacement replacement replacement replacement

SLIDE 17

Linkages Linkages Linkages Linkages

Many isolated departments

Training

CPD

South

South – – South South

Exchanges

Protocols

Protocols

Protocols

Protocols

Staff

Staff

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Access to information Access to information Access to information Access to information

Journals

$/Gbyte/month

Journals

Cost

Cost

Language

Language

1800 2000

g g g g

On

On-

line access

line access

Meetings

1500 500 1000 20 500 US Africa

SLIDE 19

Education about cancer Education about cancer Education about cancer Education about cancer

Medical students

Radiation oncology staff

Regional training centres

Regional training centres Regional training centres Regional training centres

Distance learning courses

SLIDE 20

Safety Safety Safety Safety

Inter

Inter-centre dosimetry centre dosimetry

Inter

Inter centre dosimetry centre dosimetry

Maintenance

Common protocols

Source security

SLIDE 21

Conclusions Conclusions Conclusions Conclusions

Cancer is a major problem in LMI

Cancer is a major problem in LMI j p j p

Radiotherapy is essential and viable

Cobalt is preferred

Cobalt is preferred Pl i Pl i

Planning

Investment

Linkages

Information

Education

Education Education Education

Safety

PACT