Radiation therapy – Delivery in LMIC Dr Furaha Serventi Radiation and clinical oncologist Head of cancer care centre KCMC

Introduction The past decades have seen a progressive increase in the global cancer burden, with two thirds of cancer cases in low and middle income countries Approximately 50-60% of newly diagnosed cancer patients will need radiotherapy , and 25% of them might receive second course (Owen JB et al, 1997).

Africa Africa includes 51 LMIC and is the region with the largest proportion of LIC (26) Is the region with lowest access to radiotherapy Between 1991 and 2010 the number of cases with indication of radiotherapy increased 239% and total number of machines needed is 1,273 and additional 995 Hannah,T.P. et al

Total number of linear accelerators – 194 Total number of Co60 – 84 Total number of LINAC in LIC – 7 Total number of Co60 in LIC – 8 ( 53%) Machines/ million population – 0.26 for whole population and 0.029 for its LIC

Estimate of Radiotherapy machines required in Tanzania International recommendations - 1-3 mega voltage machines per 1 million population in Low Income Countries like Tanzania With estimated 50 million people – 50 -150 mega voltage machines are required to provide adequate care

Current situation in Tanzania Ocean Road Cancer Institute (ORCI) – The only cancer centre offering radiotherapy services The centre is currently equipped with 2 mega voltage (cobalt) machines and 1 Brachytherapy machine- Low dose rate This is less than 5% of the required number of machines

Problem statement Grossly inadequate number of machines Frequent machine breakdowns as a result of machines working beyond capacity Frequent delays in changing source – treatment takes longer for every patient

Indirect Patients needing to travel long distances to get treated Lack of free hostel facilities Unacceptable delays in commencing therapy ( 3-9 months) discourage referrals for short, cost-effective palliative treatments and a lost window period for local control in curative treatments

Addressing the needs (Levin CV et al 1999) Research conducted in 51 countries in Africa observed that better radiation therapy facilities in North and South African countries is because : concerted political will, government commitment and non-governmental organizations' involvement in funding cancer care

Tanzania currently has 2 newly established cancer centres Both these centres have set cooperative efforts through MOUs between local centre, Tanzanian government and international partners to address the inadequacy of radiation services in Tanzania With RT a capital-intensive form of therapy – these collaborative efforts will serve significantly in sustaining

KCMC Cancer care Centre

Plan for KCMC With RT a capital-intensive form of therapy, collaborative efforts with FCCT has made it possible for: KCMC to develop a proposal for establishing a comprehensive radiation unit Government to commit itself to providing funds for construction of bunkers Development of a concrete plan for purchase of radiotherapy machines with cut edge technology

Staff allocation One radiation oncologist currently at KCMC Plans underway to recruit medical doctors and support staff to train in : radiation oncology Medical physics Radiotherapy

Conclusion Setting of a radiation oncology unit is capital intensive both in infrastructure, machinery and staff training FCCT/KCMC partnership is setting standards and beating all odds to provide access of high quality treatment and cut edge technology for the most vulnerable, most underprivileged in Tanzania

At last their cries have been heard! Asante(Thank you)