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      Status of Government-Funded Radiotherapy Services in Nigeria

      research-article
      Author(s): , MBBS, MPH, MD 1 , 2 , , BSc, MSc 3 , 4 , 5 , , , PhD 3 , 6 , , MBBS, FMCR, MD 7 , , MBBS, MD 1 , , MBBS, MD 8 , , MBBCh, FMCR, MD 9 , , PhD 10 , , BSc 10 , 11 , , MBBS 12 , , MBBS 13 , 14 , , MBBS 15 , , MBBS, MSc, MD 16 , , MBChB, MSc, MD 17 , , MBBS 18 , , MBBS, MD 19 , , PhD 20 , 21 , , MBBS 21 , , MBBS, MD 22 , , MBBS 23 , , MBBS 7 , , MD, PhD 24 , , MD 24 , , MD, PhD 25 , 26
      Publication date (Electronic):
      Journal: JCO Global Oncology
      Publisher: Wolters Kluwer Health

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          Abstract

          PURPOSE

          Access to radiotherapy (RT) is now one of the stark examples of global cancer inequities. More than 800,000 new cancer cases require potentially curative or palliative RT services in Africa, arguably <15% of these patients currently have access to this important service. For a population of more than 206 million, Nigeria requires a minimum of 280 RT machines for the increasing number of cancer cases. Painfully, the country has only eight Government-funded RT machines. This study aimed to evaluate the status of the eight Government-funded RT services in Nigeria and their ability to deliver effective RT to their patients.

          METHODS

          A survey addressing 10 critical areas was used to assess the eight Government-funded RT services in Nigeria.

          RESULTS

          Unfortunately, six of the eight centers (75%) surveyed have not treated patients with RT because they do not have functioning teletherapy machines in 2021. Only two RT centers have the capability of treating patients using advanced RT techniques. There is no positron emission tomography-computed tomography scan in any of the Government-funded RT centers. The workforce capacity and infrastructure across the eight centers are limited. All of the centers lack residency training programs for medical physicists and radiation therapy technologists resulting in very few well-trained staff.

          CONCLUSION

          As the Nigerian Government plans for the new National Cancer Control Plan, there is an urgent need to scale up access to RT by upgrading the RT equipment, workforce, and infrastructure to meet the current needs of Nigerian patients with cancer. Although the shortfall is apparent from a variety of RT-capacity databases, this detailed analysis provides essential information for an implementation plan involving solutions from within Nigeria and with global partners.

          Abstract

          Nigeria has the highest burden of cancer in SSA. What is the state of access to radiotherapy in this population?

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          Most cited references25

          • Record: found
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          Need for radiotherapy in low and middle income countries – the silent crisis continues.

          E.H. Zubizarreta, E Fidarova, B. Healy … (2015)
          About 57% of the total number of cancer cases occur in low and middle income countries. Radiotherapy is one of the main components of cancer treatment and requires substantial initial investment in infrastructure and training. Many departments continue to have basic facilities and to use simple techniques, while modern technologies have only been installed in big cities in upper-middle income countries. More than 50% of cancer patients requiring radiotherapy in low and middle income countries lack access to treatment. The situation is dramatic in low income countries, where the proportion is higher than 90%. The overall number of additional teletherapy units needed corresponds to about twice the installed capacity in Europe. The figures for different income level groups clearly show the correlation between gross national income per capita and the availability of services. The range of radiotherapy needs currently covered varies from 0% and 3-4% in low income countries in Latin America and Africa up to 59-79% in upper-middle income countries in Europe and Central Asia. The number of additional radiation oncologists, medical physicist, dosimetrists and radiation therapists (RTTs) required to operate additional radiotherapy departments needed is 43 200 professionals. Training and education programmes are not available in every developing country and in many cases the only option is sending trainees abroad, which is not a cost-effective solution. The implementation of adequate local training should be the following step after establishing the first radiotherapy facility in any country. Joint efforts should be made to establish at least one radiotherapy facility in countries where they do not exist, in order to create radiotherapy communities that could be the base for future expansion.
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            An image-based deep learning framework for individualising radiotherapy dose: a retrospective analysis of outcome prediction

            Bin Lou, Semihcan Doken, Tingliang Zhuang … (2019)
            Background: Radiotherapy continues to be delivered uniformly without consideration of individual tumor characteristics. To advance toward more precise treatments in radiotherapy, we queried the lung computed tomography (CT)-derived feature space to identify radiation sensitivity parameters that can predict treatment failure and hence guide the individualization of radiotherapy dose. Methods: We used a cohort-based registry of 849 patients with cancer in the lung treated with high dose radiotherapy using stereotactic body radiotherapy. We input pre-therapy lung CT images into a multi-task deep neural network, Deep Profiler, to generate an image fingerprint that primarily predicts time to event treatment outcomes and secondarily approximates classical radiomic features. We validated our findings in an independent study population ( n = 95). Deep Profiler was combined with clinical variables to derive i Gray, an individualized dose that estimates treatment failure probability to be <5%. Findings: Radiation treatments in patients with high Deep Profiler scores fail at a significantly higher rate than in those with low scores. The 3-year cumulative incidences of local failure were 20.3% (95% CI: 16.0–24.9) and 5.7% (95% CI: 3.5–8.8), respectively. Deep Profiler independently predicted local failure (hazard ratio 1.65, 95% 1.02–2.66, p = 0.04). Models that included Deep Profiler and clinical variables predicted treatment failures with a concordance index of 0.72 (95% CI: 0.67–0.77), a significant improvement compared to classical radiomics or clinical variables alone ( p = <0.001 and <0.001, respectively). Deep Profiler performed well in an external study population ( n = 95), accurately predicting treatment failures across diverse clinical settings and CT scanner types (concordance index = 0.77 [95% CI: 0.69–0.92]). i Gray had a wide dose range (21.1–277 Gy, BED), suggested dose reductions in 23.3% of patients and can be safely delivered in the majority of cases. Interpretation: Our results indicate that there are image-distinct subpopulations that have differential sensitivity to radiotherapy. The image-based deep learning framework proposed herein is the first opportunity to use medical images to individualize radiotherapy dose.
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              Status of radiotherapy resources in Africa: an International Atomic Energy Agency analysis.

              Debbie van Baarle, Jean Bourque, M Wahab … (2013)
              Radiation therapy is an important component of cancer control programmes. The scarcity of radiation oncology resources in Africa is becoming more severe as cancer incidence increases in the continent. We did a longitudinal assessment of the status of radiation oncology resources in Africa to measure the extent of the problem and the effects of programmes designed to enhance radiation services in the continent. Radiation oncology departments in Africa were surveyed through the Directory of Radiotherapy Centres, and this information was supplemented by that available from International Atomic Energy Agency Regional African and Interregional project reports for 2010. Of 52 African countries included, only 23 are known to have teletherapy. These facilities are concentrated in the southern and northern states of the continent. Brachytherapy resources (high-dose rate or low-dose rate) were only available in 20 of the 52 African countries. Although progress has been made in the establishment of radiation oncology services in some countries, a large need still exists for basic radiation services, and much resource mobilisation is needed for services to keep pace with the burgeoning populations of many countries. Copyright © 2013 Elsevier Ltd. All rights reserved.
              Article 0 comments Cited 48 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): JCO Glob Oncol
                Journal ID (iso-abbrev): JCO Glob Oncol
                Journal ID (hwp): go
                Journal ID (publisher-id): GO
                Title: JCO Global Oncology
                Publisher: Wolters Kluwer Health
                ISSN (Electronic): 2687-8941
                Publication date Collection: 2023
                Publication date (Electronic): 22 June 2023
                Publication date PMC-release: 22 June 2023
                Volume: 9
                Electronic Location Identifier: e2200406
                Affiliations
                [ 1 ]Radiation Oncology Department, National Hospital Abuja, Abuja, Nigeria
                [ 2 ]College of Medicine, University of Abuja, Gwagwalada, Abuja, Nigeria
                [ 3 ]Project PINK BLUE—Health & Psychological Trust Centre, Abuja, Nigeria
                [ 4 ]Department of Sociology & Gerontology, Miami University, Oxford, OH
                [ 5 ]Scripps Gerontology Center, Miami University, Oxford, OH
                [ 6 ]Department of Psychology, University of Nigeria Nsukka, Enugu, Nigeria
                [ 7 ]Radiation and Clinical Oncology Department, National Hospital Abuja, Abuja, Nigeria
                [ 8 ]Neurosurgery Department, National Hospital Abuja, Abuja, Nigeria
                [ 9 ]Department of Radiology, National Hospital Abuja, Abuja, Nigeria
                [ 10 ]Medical Physics Department, National Hospital Abuja, Abuja, Nigeria
                [ 11 ]Radiotherapy Department, Asi Ukpo Comprehensive Cancer Center, Calabar, Nigeria
                [ 12 ]Radiation Oncology Department, Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, Nigeria
                [ 13 ]Radiology Department, Gombe State University, Gombe, Nigeria
                [ 14 ]Department of Radiotherapy and Oncology, Federal Teaching Hospital Gombe, Gombe, Nigeria
                [ 15 ]Radiation Oncology Department, Nigeria Sovereign Investment Authority-Lagos University Teaching Hospital (NSIA-LUTH), Lagos, Nigeria
                [ 16 ]Radiation Oncology Department, University of Nigeria Teaching Hospital (UNTH), Ituku Ozalla, Enugu, Nigeria
                [ 17 ]University of Ibadan/University College Hospital Ibadan, Ibadan, Nigeria
                [ 18 ]Radiation Oncology Department, Usman Danfodio University Teaching Hospital (UDUTH), Sokoto, Nigeria
                [ 19 ]Radiation Oncology Department, University of Benin Teaching Hospital (UBTH), Edo State, Nigeria
                [ 20 ]Centre for Energy Research and Training, Ahmadu Bello University, Zaria, Nigeria
                [ 21 ]Nigeria Atomic Energy Commission (NAEC), Abuja, Nigeria
                [ 22 ]Radiology Department, University of Abuja Teaching Hospital (UATH), Gwagwalada, Abuja, Nigeria
                [ 23 ]University of Abuja Teaching Hosiptal (UATH), Gwagwalada, Abuja, Nigeria
                [ 24 ]International Cancer Expert Corps (ICEC) Inc, Washington, DC
                [ 25 ]University of Oxford, Oxford, United Kingdom
                [ 26 ]European Centre for Nuclear Research (CERN), Geneva, Switzerland
                Author notes
                Runcie C.W. Chidebe, BSc, MSc, Project PINK BLUE—Health & Psychological Trust Centre, 11 Moses Majekodunmi Crescent, Utako, Abuja 900001, Nigeria; e-mail: runcie.chidebe@ 123456projectpinkblue.org .
                Author information
                https://orcid.org/0000-0003-0149-1617
                https://orcid.org/0000-0002-6025-776X
                https://orcid.org/0000-0001-5379-8915
                https://orcid.org/0000-0002-6583-3770
                https://orcid.org/0000-0002-4431-7777
                https://orcid.org/0000-0002-6383-3961
                https://orcid.org/0000-0003-3121-1663
                https://orcid.org/0000-0003-1378-349X
                Article
                Publisher ID: GO.22.00406
                DOI: 10.1200/GO.22.00406
                PMC ID: 10497276
                PubMed ID: 37348033
                SO-VID: 6d689d8b-6d70-46f7-8e50-1be7539b5cdf
                Copyright © © 2023 by American Society of Clinical Oncology
                License:

                Licensed under the Creative Commons Attribution 4.0 License: https://creativecommons.org/licenses/by/4.0/

                History
                Date received : 25 January 2023
                Date revision received : 20 February 2023
                Date accepted : 18 April 2023
                Page count
                Figures: 2, Tables: 7, Equations: 0, References: 25, Pages: 0
                Categories
                Subject: ORIGINAL REPORTS
                Subject: Radiation Oncology
                Custom metadata
                OPEN-ACCESS TRUE

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