By Gustaf Salford

Global disparities in access to quality health care are not new, but their seemingly entrenched nature cannot be a cause for complacency. Somewhat paradoxically, every new medical breakthrough splashed across front pages and television screens of developed economies increases disparities as health care systems in low- and middle-income struggle to acquire and implement new technologies and therapeutics. While drug access programs sponsored by non-governmental organizations or pharmaceutical companies may make some medical therapies available to more patients, expanding access to health care that requires medical device infrastructure is more challenging. Consequently, there are significant disparities in access to radiation therapy for the treatment of cancer.

Radiation therapy is needed by 50%-60% of cancer patients globally. Yet, despite it being a pillar of cancer therapy, low- and middle-income countries have access to only 32% of global radiation therapy resources even though they bear 80% of the global cancer burden. Even within developed economies, access to radiation therapy may vary based on geography or socioeconomic status, with cutting-edge radiation care more readily available in large cities with academic centers dedicated to cancer care and research than in rural community hospitals.

Effectively addressing global disparities in cancer care and outcomes requires increasing access to cutting-edge radiation therapy. Moreover, while there are decades of data demonstrating the safety and efficacy of traditional radiation therapy approaches in diverse cancer indications, more recent advances in radiation therapy technology now enable personalized regimens adapted to each patient’s anatomy and to the unique characteristics of their tumors. Personalized cancer therapy often brings to mind medicines that target specific tumor-associated proteins expressed in a patient’s tumor, or cell therapies made from a patient’s own T-cells. However, in the context of addressing global health disparities, it is critical to expand our concept of personalized therapy beyond the modality of treatment used, and to focus on the individual who is being treated.

Innovators of cutting-edge radiation therapy systems have critical roles to play in helping to address disparities and expand access to potentially life-saving care. A key challenge to making radiation therapy more broadly available is that the number of patients treated is dependent on the number and location of radiation therapy devices. Advanced radiation therapy may only be available in one or a few large centers in a country, placing significant burdens on patients who must travel large distances to reach these sites. Manufacturers of radiation therapy technologies can help address this disparity by establishing corporate programs or supporting other organizations that are committed to making radiation therapy broadly available to the millions of people with cancer in underserved markets around the world

An insufficient number of radiation therapy personnel, including medical physicists, radiation oncologists is another key bottleneck to expanding access to radiation therapy. Fortunately, there are several ways in which radiation therapy technology companies can help address this critical challenge. One is to develop partnership programs taught by thought leaders and established world-renowned sites for peer-to-peer knowledge sharing. Such programs can help train additional personnel where they are most needed. Similarly, device manufacturers can deploy Clinical Application Specialists around the world to provide first-hand clinical expertise and experience that enables broader adoption and use of radiation therapy equipment and treatment options in additional clinical centers. It is also essential to develop multi-modal educational options, from in-person to fully digital programs, to facilitate learning regardless of where care providers are located. Finally, radiation therapy technology companies can establish and or support philanthropic organizations whose mission includes supporting research, peer-to-peer clinical training and other educational efforts to strengthen sustainable access to cancer care.

Infrastructure challenges also may pose a significant obstacle to operating and maintaining cutting-edge radiation therapy delivery systems. These challenges include space constraints within care centers, inconsistent or unreliable energy sources, and lack of trained technicians to repair/maintain equipment. Prioritizing development of radiation therapy delivery devices that provide safe and effective radiation therapy while operating efficiently in smaller care centers and resource-constrained settings is essential for broadening access to care. This may include devices that have smaller footprints, require less space to operate and have lower acquisition and utilization costs. Additionally, systems that reduce the time needed for each treatment slot may enable more patients to be treated each day, further increasing availability of radiation therapy. Device manufacturers should also leverage automated systems to perform remote diagnosis of radiation therapy systems, which can provide advance notification when parts need to be replaced and avoid unplanned equipment shutdowns and outages.

Even when advanced radiation care may be available within a region or territory, community physicians and community hospitals may not be familiar with the latest advances in radiation therapy. This may lead to patients not being referred to other sites that may be able to offer them optimal treatment that may improve cancer outcomes. Device manufacturers can help address the challenge by partnering with advocacy groups, policy makers, industry peers and academia to improve educational outreach and increase funding for the latest innovations in radiation therapy.

Perhaps most importantly, radiation therapy device manufacturers must recognize that innovating technology isn’t enough. Rather, they must recognize that the approval of a new technology is a step in a longer and more complex process for improving care for cancer patients, rather than an end goal. New technologies only improve human health when they are broadly and equitably available to all patients who may benefit from them. A growing body of data makes it abundantly clear that geography, socioeconomic status, insurance coverage, education, and language all play critical roles in – and can serve as significant barriers – to connecting cancer patients with optimized care. Effectively addressing the global cancer epidemic requires that cancer care innovators focus not only on what goes on inside their design labs and manufacturing facilities but also on how their products are used in real-world settings to bring hope to patients with cancer.

About the author: Gustaf Salford is the president and CEO of Elekta.