ABSTRACT
Purpose: Sub-Saharan Africa has the highest burden of cervical cancer in the world. The African continent has only 5% of the world's cancer care resources, and brachytherapy is an important part of treatment of cervical cancer. This study explored the availability of brachytherapy units in Africa. Material and methods: We used publicly available data on cervical cancer and brachytherapy from GLOBOCAN 2018 database hosted by IARC and Directory of Radiotherapy Centers (DIRAC) presented by IAEA, respectively. Number of brachytherapy units per 1,000 new cases was calculated as an index for comparison between groups. Results: There are 101 brachytherapy units in 20 African countries, accounting for 3% (101/3,375) of total global units. Sub-Saharan Africa accounts for half of these units (50/101). Egypt has the highest number of units per 1,000 new cases (23.7 units/1,000 new cases), while Nigeria has the least with 0.13 units per 1,000 new cases. No country in central African region has a brachytherapy unit. More than 70% of brachytherapy units are located in five countries (Algeria, Kenya, Egypt, Morocco, and South Africa). Conclusions: In order to treat 90 percent of invasive cervical cancer on the continent, Africa needs a continental political action plan and massive investment in brachytherapy equipment over the next ten years.
ABSTRACT
BACKGROUND: Access and availability of radiotherapy treatment is limited in most low- and middle-income countries, which leads to long waiting times and poor clinical outcomes. The aim of our study is to determine the magnitude of waiting times for radiotherapy in a resource-limited setting. METHODS: This is a retrospective cohort study of patients with the five most commonly treated cancers managed with radiotherapy between 2010 and 2014. Data includes diagnosis, patients' demographics and treatment provided. The waiting time was categorised into intervals (1) between diagnosis and first radiation consultation (2) First consultation to radiotherapy treatment (3) Decision-to-treat to treatment and (4) Diagnosis to treatment. RESULTS: A total of 258 cases were involved, including cervical (50%; 129/258), breast (27.5%; 71/258), nasopharynx (12.8%; 33/258), colorectal (5%; 13/258) and prostate cancers (4.7%; 12/258). Mean age was 48 (±12.9) years. Treatment with radical intent comprised 67% (178/258) of cases, while 33% (80/258) had palliative treatment. The median time from diagnosis to first radiation consultation was 40 (IQR 17-157.75) days for all the patients, with prostate cancer having the longest time - 305 days (IQR 41-393.8). The median time between the first radiation oncology consultations and first radiotherapy treatment was 130.5 (IQR 14-211.5) days; cervical cancer patients waited a median of 139 (IQR 13-195.5) days. The median time between diagnosis and first radiotherapy for breast cancer patients was 329 (IQR 207-464) days, compared to 213 (IQR 101.5-353.5) days for all the patients. CONCLUSION: The study shows that waiting time for radiotherapy in Nigeria was generally longer than what is recommended internationally. This reflects the need to improve access to radiotherapy in order to improve cancer treatment outcomes in resource-limited settings.
