Novel coronavirus mitigation measures implemented by radiotherapy centres in low and middle-income countries: a systematic review.

BACKGROUND: The aim of the study was to identify strategies adopted by radiotherapy centres in low- and middle-income countries (LMICs) to mitigate the effects of COVID-19. Studies summarising COVID-19 mitigation strategies designed and implemented by radiotherapy centres in LMICs to avoid delays, deferrments and interruptions of radiotherapy services are lacking. MATERIALS AND METHODS: A systematic review was conducted and reported in accordance with the preferred reporting items for systematic review and meta-analysis guideline. Ovid Embase, Ovid MEDLINE and CINAHL were searched for peer-reviewed articles that reported measures adopted by radiotherapy centres in LMICs to reduce the risk of COVID-19. Information on different strategies were extracted from the included studies and textual narrative synthesis was conducted. RESULTS: Of 60 articles retrieved, eleven were included. Majority of the studies were conducted in China. Ten of the included studies employed a qualitative design. Four themes were identified: preparing and equipping staff; reinforcing infection prevention and control policies; strengthening coordination and communication; and maintaining physical distancing. Studies reported that radiotherapy centres had: formed COVID-19 response multidisciplinary team; maximised the use of telehealth; adjusted the layout of waiting areas; divided staff into teams; dedicated a room for isolating suspected cases; and adopted triage systems. CONCLUSIONS: Local adaptation of established global strategies coupled with timely development of guidelines, flexibility and innovation have allowed radiotherapy leaders to continue to deliver radiotherapy services to cancer patients in LMICs during the COVID-19 crisis. Robust data collection must be encouraged in LMICs to provide an evidence-based knowledge for use in the event of another pandemic.

Improvements in radiation therapy services in Myanmar: 2012-2020.

INTRODUCTION: Myanmar is a Low-Middle Income Country (LMIC) in South-East Asia. Over the last decade, reforms to the health system have included significant improvements in the delivery of radiation therapy services in both government and private-for-profit sectors. METHODS: This review uses limited cancer registry data, observations from in-person visits, and data from key informants in Myanmar radiation therapy centres, to report on developments in radiation therapy services in recent years. RESULTS: Rising national cancer incidence estimates presented in this article are supplemented with annual cancer case and radiation therapy course completion statistics from three hospital / regional contexts. Strategies which enabled the increased delivery of radiation therapy services are described. Data regarding the geographic locations of radiation therapy centres, their equipment and software inventories, is tabulated. The impact on clinical practice standards through upgraded equipment and software used for treatment planning and delivery is discussed. Clinical staffing at each centre is catalogued, role descriptions are given, and increases in staff numbers in recent years are documented. The present clinical and academic education challenges for radiation therapy staff and the importance of these issues for technical practice advancements are discussed. CONCLUSION: Myanmar's successes and continued challenges in radiation therapy service delivery are emulated in other LMIC's. Strategic planning for new and existing radiation therapy centres, further staff increases and improved academic and clinical learning for radiation therapy staff should assist in meeting these challenges. Further international engagement could also enhance these processes.

Improving Health and Cancer Services in Low-Resource Countries to Attain the Sustainable Development Goals Target 3.4 for Noncommunicable Diseases.

The United Nations Sustainable Development Goals 2015 to 2030 includes a specific goal for health (Sustainable Development Goal [SDG] 3) with 13 targets, including SDG3.4 for the control and treatment of noncommunicable diseases (NCDs), namely, cardiovascular diseases, cancer, diabetes, and chronic lung disease. There is considerable concern that SDG3.4 may not be achieved. The WHO Best Buys for NCDs has emphasized prevention, and although crucial, it alone will not achieve the 30% reduction in NCDs by 2030. Likewise, a strengthened health system is required as all NCDs are likely to require hospital facilities and community services for optimal management. This is a major problem for low-resource countries (LRCs) -that is, low-income countries and lower-middle-income countries-as most currently have a poorly developed health system, including cancer services, in need of upgrading. This is a result of the extreme poverty of LRCs, where 40% to 80% of the population live on less than USD $1.25 per day, with the average health spending by governments in low-income countries at $110 per person per year. In this article, we outline a comprehensive national cancer services plan for LRCs. Surgery, radiotherapy, and chemotherapy for cancer treatment also require input from other specialties, such as anesthesia, pathology, laboratory medicine, a blood bank, and diagnostic radiology. This will provide a focus for adding additional specialties, including cardiology, respiratory medicine, and psychiatry, to support the management of all NCDs and to contribute to the overall strengthening of the health system. The national cancer services plan for LRCs will require significant funding and input from both in-country and overseas experts in health, cancer, and finance working collaboratively. Success will depend on thoughtful strategic planning and providing the right balance of overseas support and guidance, but ensuring that there is in-country ownership and control of the program is essential.

Practice patterns of radiation therapy technology in Australia: results of a national audit.

INTRODUCTION: This article presents the results of a single-day census of radiation therapy (RT) treatment and technology use in Australia. The primary aim of the study was to ascertain patterns of RT practice and technology in use across Australia. These data were primarily collated to inform curriculum development of academic programs, thereby ensuring that training is matched to workforce patterns of practice. METHODS: The study design was a census method with all 59 RT centres in Australia being invited to provide quantitative summary data relating to patient case mix and technology use on a randomly selected but common date. Anonymous and demographic-free data were analysed using descriptive statistics. RESULTS: Overall data were provided across all six Australian States by 29 centres of a possible 59, yielding a response rate of 49% and representing a total of 2743 patients. Findings from this study indicate the increasing use of emerging intensity-modulated radiotherapy (IMRT), image fusion and image-guided radiation therapy (IGRT) technology in Australian RT planning and delivery phases. IMRT in particular was used for 37% of patients, indicating a high uptake of the technology in Australia when compared to other published data. The results also highlight the resource-intensive nature of benign tumour radiotherapy. CONCLUSIONS: In the absence of routine national data collection, the single-day census method offers a relatively convenient means of measuring and tracking RT resource utilisation. Wider use of this tool has the potential to not only track trends in technology implementation but also inform evidence-based guidelines for referral and resource planning.