New guidelines from the World Health Organization (WHO) and the International Atomic Energy Agency (IAEA) on the procurement of radiotherapy equipment could improve access to this life-saving cancer treatment option, which is still lacking in many parts of the world.
New technical guidance wants to ensure that the selection of radiotherapy equipment is appropriate to the context of the state and the health facility, that treatment is carried out safely, that quality is maintained and that services are sustainable.
The publication is intended for medical physicists, biomedical and clinical engineers, radiation oncologists, oncologists and all others responsible for the production, planning, selection, procurement, regulation, installation or use of radiotherapy equipment. It was developed as part of an ongoing collaboration between the WHO and the IAEA to promote safety and quality in the medical use of radiation technology.
More than half of cancer patients require radiotherapy
More than 50% of cancer patients require radiotherapy as part of cancer care, and it is often used to treat the most common types, such as breast, cervical, colon, and lung cancers. However, access to radiotherapy is inadequate, especially in low- and middle-income countries.
“IAEA data show that about one-third of countries still do not have radiotherapy available, 28 of which are in Africa,” said May Abdel-Wahab, director of the IAEA’s human health department. “Many of them would benefit from increased access to radiotherapy services. The key is to adapt oncology radiation solutions to the situation on the ground, backed by an appropriate safety infrastructure. ”
The types of radiotherapy equipment covered by the guide include external beam radiotherapy devices (both Cobalt-60 and linear accelerators), brachytherapy devices that apply radiation sources directly to tumors, and complementary imaging devices such as conventional or computed tomography (CT) simulators, as well as other tools necessary for safe operation and quality control. Depending on the type of radiotherapy apparatus, the need for specialized professionals and infrastructure, as well as quality assurance and maintenance, may vary.
Safety is also extensively covered, with information provided on bunker planning for radiotherapy equipment placement, protection for walls, floors and ceilings, and emergency buttons for treatment and control rooms. In addition, clear guidance is provided on what is needed to ensure equipment functionality for optimal equipment life, usually over a period of 10-15 years.
Selecting radiotherapy systems appropriate to certain settings and tailored to the existing workforce helps ensure safe radiotherapy. It contributes to improving access to life-saving treatment by minimizing service interruptions due to machine downtime and builds a solid foundation for further service expansion when the health system is ready to adopt more complex radiotherapy systems.
“Although interruptions to radiotherapy equipment preceded COVID-19,” said Dr. Bente Mikkelsen, director of the WHO’s Department of Noncommunicable Diseases, “they worsened during the pandemic due to a breakdown in global supply chains and obstacles to the free movement of technical service personnel. Any improvement that reduces interruptions can make a difference between life and death for patients whose tumors continue to grow while waiting for treatment. “
Radiotherapy equipment, however, is only one element of cancer management services. Others that need to be in place relate to early detection, diagnostic imaging, laboratory tests, pathology, surgery, systemic treatment, and palliative care. The technologies associated with all of these services are listed in the WHO List of Priority Medical Devices for Cancer Treatment.
Global Cancer Initiatives
One of the areas in which radiotherapy plays an important role is the treatment of cervical cancer, one of the leading causes of cancer death among women and for which the WHO launched a global elimination strategy last year.
“Cervical cancer is curable if caught early,” said Dr. Nono Simelela, WHO Assistant Director-General for Strategic Priorities. “We have life-saving tools. Radiotherapy is one of them. It is also one of the most effective tools for relieving the pain and suffering associated with advanced cancer. ”
Unitaid, a global health agency dedicated to finding innovative solutions to prevent, diagnose and treat major communicable diseases in low- and middle-income countries, recently expanded its portfolio to include concomitant HIV diseases, such as cervical cancer. “Although Unitaid’s catalytic investments are focused on cervical cancer screening programs, key functions such as procuring radiotherapy are an important component of continuity of care for all women in need of invasive cancer treatment,” said Robert Matiru, director of Unitaid’s program department.
Radiotherapy is also an integral part of breast and child cancer control, two other major WHO global initiatives against cancer. The changes, which will ease the new guidelines, will also benefit millions of cancer patients worldwide, including women seeking treatment for breast cancer, the most commonly diagnosed form of cancer in the world today.
The new specifications are a supplement to the previous version issued by the IAEA, published in 2008.
Note for journalists:
The WHO supports countries in strengthening their national cancer policies and health systems, ensuring that priorities are set appropriately and that affordable, fair and quality cancer care is established or increased as part of universal health care. WHO’s focus is on childhood, cervical, and breast cancers.
The IAEA supports countries in using nuclear and radiation medicine to fight a range of non-communicable diseases, including cancer. The Agency supports countries in resource mobilization and equipment procurement, as well as through training, education, research, guidance documents, and in conducting quality assessments and missions.
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