2330 - Radiotherapy Access, Infrastructure Gaps and Financial Burden in Bangladesh: A National Landscape Analysis from a Lower-Middle-Income Country
Presenter(s)
N. T. Hossain1, A. Hossain2, A. M. M. S. Alam1, M. A. Ahsan3, A. Paul Chowdhury3, J. Ferdause3, T. J. Tina1, A. Kamal Uddin4, S. Salsabil5, M. M. Karim6, R. Sharif1, S. S. Soni7, S. C. Sadiq8, L. Khoshin9, and M. S. S. Huq10; 1Ahsania Mission Cancer and General Hospital, Dhaka, Bangladesh, 2National Institute of Cancer Research and Hospital, Dhaka, Dhaka, Bangladesh, 3Ahsania Mission Cancer and General Hospital, Dhaka, Dhaka, Bangladesh, 4Labaid Cancer Hospital And Super Speciality Centre, Dhaka, Bangladesh, 5Dhaka Medical College, Dhaka, Bangladesh, 6Bangladesh Medical University, Dhaka, Bangladesh, 7All India Institute of Medical Sciences, India, India, 8INMOL Hospital, Lahore, Pakistan, 9B.P. Koirala Memorial Cancer Hospital, Chitwan, Nepal, 10Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA
Purpose/Objective(s):
Low- and Middle-Income Countries (LMICs) face 57% of the global cancer burden with only 5% of resources. Bangladesh faces a rising cancer incidence of approximately 200,000 new cases annually, with 60% presenting at locally advanced disease and cancer accounting for 12% of deaths (8% rise from 2018 to 2022). Radiotherapy (RT) is required in 50-60% of cancer patients for curative or palliative intent. However, access to RT remains severely constrained. This study aimed to evaluate national RT infrastructure, workforce capacity, waiting time implications, and financial burden on patients.Materials/Methods:
A national landscape analysis was conducted using publicly available data, institutional reports, and hospital records. Radiotherapy centers were categorized into public and private sectors. We evaluated the current inventory of RT machines, the specialized workforce (Radiation Oncologists, Medical Physicists, and Technologists), the waiting time for RT and the impact of the government’s one-time financial grant on treatment adherence. Workforce requirements were estimated based on recommendations from the International Atomic Energy Agency (IAEA) and the World Health Organization (WHO). Government financial assistance and out-of-pocket costs were analyzed descriptively.Results:
Bangladesh (population 170 million) requires at least 180 RT machines but currently operates only 32 machines across 19 centers (4 government, 15 private), representing an 82.2% deficit. Furthermore, a severe workforce shortage exists: only 32.5% of the required number of Radiation Oncologists, 15.6% of Medical Physicists, and 20% of Radiation Technologists are available. In the public sector, the wait time for RT initiation reaches 12 months, compared to 2.5-3 months in the private sector, which contributes to significant treatment drop-outs and upstaging of disease. Financially, the government’s one-time grant of 50,000 BDT ($420 USD) is insufficient for private care, where costs can reach 300,000 BDT ($2450 - $2460 USD), leaving a minimum 83.3% funding gap for patients unable to access the overburdened public system.Conclusion:
The radiotherapy landscape in Bangladesh is characterized by a triple threat of infrastructure deficit, workforce crisis, and extreme financial toxicity. The 12-month public sector waiting list renders curative intent impossible for many, while the private sector remains financially inaccessible despite the government grant. To prevent financial catastrophe and improve survival, urgent national investment in RT expansion, workforce development, and a sustainable insurance model is required to improve equitable access to cancer care in this lower-middle-income setting.