Fighting cancer: ICMR study reveals big gap in radiotherapy access

Why is the study significant?

Radiotherapy continues to be a key part of cancer treatment and adequate availability and access would ensure better outcomes for patients. More importantly, four of the cancer sites that account for 60 per cent of the total radiotherapy requirement — breast, head and neck, lung, and cervical cancer — are likely to go up in the future. The study says the demand for radiotherapy may increase by 70 per cent to 100 per cent in countries such as India.

Dr Prashant Mathur, one of the authors of the study and the director of the ICMR-National Centre for Disease Informatics and Research, said, “The study indicates that about 126-222 radiotherapy machines would not be required if the cancer could be diagnosed at an early stage. Efforts to reduce the burden of these cancers (breast, head and neck, lung, and cervical) must be strengthened while advancements in treatment modalities happen so as to provide suitable alternatives to radiotherapy.”

How much gap is there between requirement and actual use of radiotherapy?

Not only is the average utilisation of radiotherapy in India low, the researchers also found that the optimal utilisation level was not met for any of the common cancers that were analysed. The gap between optimal utilisation and actual utilisation of radiotherapy was the lowest for brain cancers, with around 32 per cent of the patients in need not receiving it. This was followed by cervical cancer (39.9 per cent) and head and neck cancer (44.9 per cent). The highest gap was in lymphomas (79.1 per cent), lung (69.9 per cent) and prostate (58.5 per cent).

The study further points out that the estimated optimal utilisation of radiotherapy in India, as per its calculations, is also on the higher end. This is largely because patients come to hospitals at later stages of cancer in India, according to the study. With lymphoma being the cancer with the lowest utilisation of radiotherapy, the researchers also mention that this could be owing to toxicity associated with the treatment as well as advancements in chemotherapy and targeted therapy.

How many machines does WHO recommend?

The World Health Organisation (WHO) recommends a minimum of one radiotherapy machine per million population, with an ideal number of four per million. Considering the lower end of the recommendation, with a population of 1.45 billion, India would require around 1,450 machines. The current study pegs the number higher, ideally between 1,585 and 2,545 machines.

What is the current situation in India?

India has just over half the WHO recommended number of radiotherapy machines. There are 794 megavoltage machines currently available in the country, according to the study even though there has been an increase in the numbers. “Despite an 18 per cent increase in installed machines — from 670 to 794 — the country’s Linear Accelerator Shortage Index (LSI), calculated using current study data, remains high at 256, underscoring persistent gaps in radiotherapy availability.”

To achieve the level recommended by the study, India would need to invest anywhere between $ 64.2 to $ 81.7 million. This would cover the cost of around the average 2,241 machines required, 4,034 radiation oncologists, 2,241 medical physicists and 6,732 radiation therapists, according to the study.

Epidemiological analysis of radiation therapy utilization and its implications for cancer care in India-insights from National Cancer Registry Programme.