Presenter(s)
B. Tortelli1, E. Titovich2, and M. Abdel-Wahab2; 1Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, 2International Atomic Energy Agency, Vienna, Austria
Purpose/Objective(s): Addressing inequitable access to radiotherapy (RT) in the Central American (CA) countries Guatemala, Belize, El Salvador, Honduras, Nicaragua, Costa Rica and Panama will require ongoing efforts by policy makers and other interested parties. Data integrating cancer incidence, RT capabilities and treatment accessibility are critical to informing national cancer plans. The purpose of this study is to identify gaps between existing RT capacity and demand in the region.
Materials/Methods: Country population, income status and cancer incidence were extracted from publicly available data (World Bank Data, GLOBOCAN 2022). The International Atomic Energy Agency Directory of Radiotherapy Centers was used to identify RT centers and operational teletherapy (EBRT) and brachytherapy (BT) units. Previously reported optimal RT utilization (RTU) rates specific to cancer type and country income were used to calculate demand. BT demand was calculated using utilization rates for cervical, uterine and vaginal cancers. To calculate gaps in capacity we assumed each EBRT and BT unit could treat 450 and 500 patients per year, respectively. We used the geographic information software QGIS and TravelTime plugin to map RT centers and catchment areas (two-hour driving distance). Populations within catchment areas were calculated. The investment needed (US$) to meet RT demand was estimated based on published equipment and building costs.
Results: EBRT and high dose rate (HDR) brachytherapy is available in every country, except Belize (not included in further analysis). Patients per EBRT unit ranged from 345 (El Salvador) to 965 (Guatemala). There is sufficient brachytherapy capacity available to meet current demand in all countries. RT centers are concentrated in capital cities, with only Guatemala and Honduras offering services in other municipalities. Costa Rica (64%), El Salvador (63%) and Panama (61%) had the highest percent of the population living within 2 hours from a RT center, followed by Nicaragua (42%), Guatemala (38%) and Honduras (36%). By 2050, RT demand in the region will approximately double. The addition of 89 EBRT units and 4 HDR units will be needed. Guatemala will require the greatest increase in RT units (31 EBRT, 1 HDR) and El Salvador the lowest (3 EBRT, 0 HDR). Assuming a hub and spoke model, the number of new RT centers that need to be built to meet 2050 demand ranged from 2 (El Salvador) to 16 centers (Guatemala). The estimated cost ranged from approximately $11 million to $99 million respectively.
Conclusion: RT resources are unevenly distributed across CA. Clinics are concentrated in a few urban areas, leaving large portions of the population without access. Significant capital investment is needed to meet growing RT demand. When developing programs to build RT capacity, policymakers should carefully consider the geographic placement of resources to best reduce gaps in care. A hub and spoke model could distribute resources more evenly, increasing accessibility in a cost-effective way.