Radiation Oncology in Global Health

  • May Abdel-Wahab
  • Anja Nitzsche-Bell
  • Adam Olson
  • Alfredo Polo
  • Mira M. Shah
  • Eduardo Zubizarreta
  • Shilpen Patel


Radiation oncology is one of the three main therapeutic disciplines of clinical oncology, along with medical and surgical oncology. There are gaps in radiotherapy access worldwide—to equipment and human resources. This chapter discusses novel solutions to address these gaps with the intent of reducing the global burden of cancer.


Radiation Oncology Global Health Cancer Crisis Lower- and middle-income countries 


  1. 1.
    Halperin EC, Wazer DE, Perez CA. The discipline of radiation oncology. In: Halperin EC, Brady LW, Perez CA, Wazer DE, editors. Perez and Brady’s principles and practice of radiation oncology. 6th ed. Philadelphia: Lippincott Williams & Williams; 2013. p. 2–75.Google Scholar
  2. 2.
    The American Association of Physicists in Medicine. Available at: Accessed 27 Dec 2017.
  3. 3.
    Radiation Oncology Targeting Cancer. Available at: Accessed 27 Dec 2017.
  4. 4.
    Medical Dosimetrist Certification Board. Available at: Accessed 27 Dec 2017.
  5. 5.
    American Society of Radiologic Technologists. Available at: Accessed 27 Dec 2017.
  6. 6.
    American Registry of Radiologic Technologists. Available at: Accessed 27 Dec 2017.
  7. 7.
    Radiation Oncology Targeting Cancer. Available at: Accessed 27 Dec 2017.
  8. 8.
    Radiation Oncology Targeting Cancer. Available at: Accessed 27 Dec 2017.
  9. 9.
    Bray F, Jemal A, Grey N, Ferlay J, Forman D. Global cancer transitions according to the Human Development Index (2008–2030): a population-based study. Lancet Oncol. 2012;13:790–801.CrossRefGoogle Scholar
  10. 10.
    Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136:E359–86.CrossRefGoogle Scholar
  11. 11.
    Rosenblatt E, Acuna O, Abdel-Wahab M. The challenge of global radiation therapy: an IAEA perspective. Int J Radiat Oncol Biol Phys. 2015;91(4):687–9.CrossRefGoogle Scholar
  12. 12.
    Yap ML, Zubizarreta E, Bray F, Ferlay J, Barton M. Global access to radiotherapy services: have we made progress during the past decade. J Glob Oncol. 2016;2:207–15.CrossRefGoogle Scholar
  13. 13.
    Zubizarreta E, Van Dyk J, Lievens Y. Analysis of global radiotherapy needs and costs by geographic region and income level. Clin Oncol (R Coll Radiol). 2017;29:84–92.CrossRefGoogle Scholar
  14. 14.
    Rosenblatt E, Barton M, Mackillop W, et al. Optimal radiotherapy utilisation rate in developing countries: an IAEA study. Radiother Oncol. 2015;116:35–7.CrossRefGoogle Scholar
  15. 15.
    Abdel-Wahab M, Bourque JM, Pynda Y, et al. Status of radiotherapy resources in Africa: an International Atomic Energy Agency analysis. Lancet Oncol. 2013;14:e168–75.CrossRefGoogle Scholar
  16. 16.
    Datta NR, Samiei M, Bodis S. Radiation therapy infrastructure and human resources in low- and middle-income countries: present status and projections for 2020. Int J Radiat Oncol Biol Phys. 2014;89(3):448–57.CrossRefGoogle Scholar
  17. 17.
    Atun R, Jaffray DA, Barton MB, et al. Expanding global access to radiotherapy. Lancet Oncol. 2015;16:1153–86.CrossRefGoogle Scholar
  18. 18.
    Zubizarreta EH, Fidarova E, Healy B, Rosenblatt E. Need for radiotherapy in low and middle income countries – the silent crisis continues. Clin Oncol (R Coll Radiol). 2015;27:107–14.CrossRefGoogle Scholar
  19. 19.
    Barton MB, Frommer M, Shafiq J. Role of radiotherapy in cancer control in low-income and middle-income countries. Lancet Oncol. 2006;7:584–95.CrossRefGoogle Scholar
  20. 20.
    Abdel-Wahab M, Fidarova E, Polo A. Global access to radiotherapy in low and middle income countries. Clin Oncol (R Coll Radiol). 2017;29(2):99–104.CrossRefGoogle Scholar
  21. 21.
    Abdel-Wahab M, Zubizarreta E, Polo A, Meghzifene A. Improving quality and access to radiation therapy- an IAEA perspective. Semin Radiat Oncol. 2017;27:109–17.CrossRefGoogle Scholar
  22. 22.
    Abdel-Wahab M, Rosenblatt E, Homberg O, Meghzifene A. Safety in radiation oncology-the role of International initiatives by IAEA. J Am Coll Radiol. 2011;8(11):789–94.CrossRefGoogle Scholar
  23. 23.
    Page B, Hudson A, Brown DW, Shulman AC, Abdel-Wahab M, Fisher BJ, Patel S. Cobalt, linac, or other: what is the best solution for radiotherapy in developing countries? Int J Radiat Oncol Biol Phys. 2014;89(3):476–80. In reply to Page BR and Abdel-Wahab M. Revisiting Cobalt 60 teletherapy. Cobalt, linac, or other: what is the best solution for radiation therapy in developing countries? In Reply to Ravichandran R and Ravikumar. Int J Radiat Oncol Biol Phys. 2015;91(5):111.CrossRefGoogle Scholar
  24. 24.
    Rosenblatt E, Meghzifene A, Belyakov O, Abdel-Wahab M. The relevance of particle therapy to developing countries. Int J Radiat Oncol Biol Phys. 2015;95(1):25–9.CrossRefGoogle Scholar
  25. 25.
    Rosenblatt E, Prajogi GB, Barton M, Fidarova E, Ericksen J, Haffty B, et al. The need for competency based radiation oncology education in developing countries. Creative Educ. 2017;8(1):66–80.CrossRefGoogle Scholar
  26. 26.
    Chite Asirwa F, Greist A, Busakhala N, Rosen B, Loehrer PJ Sr. Medical education and training: building in-country capacity at all levels. J Clin Oncol. 2016;34(1):36–42.CrossRefGoogle Scholar
  27. 27.
    Efstathiou JA, Heunis M, Karumekayi T, et al. Establishing and delivering quality radiation therapy in resource-constrained settings: the story of Botswana. J Clin Oncol. 2015;34(1):27–35.CrossRefGoogle Scholar
  28. 28.
    Chabner BA, Efstathiou J, Dryden-Peterson S. visiting team from the Massachusetts General Hospital Cancer Center and our partners at the Medical School of the University of Botswana, the Princess Marina Hospital, the Gaborone Private Hospital, and the Botswana Ministry of Health. Cancer in Botswana: the second wave of AIDS in Sub-Saharan Africa. Oncologist. 2013;18(7):777–8.CrossRefGoogle Scholar
  29. 29.
    Einck JP, Hudson A, Shulman AC, et al. Implementation of a high-dose-rate brachytherapy program for carcinoma of the cervix in Senegal: a pragmatic model for the developing world. Int J Radiat Oncol Biol Phys. 2014;89(3):462–7.CrossRefGoogle Scholar
  30. 30.
    Schroeder K, Olson AC, Ackerson B, et al. Radiation needs in pediatric oncology in the lake region of Tanzania. JGO. 2016;2(3_suppl):64s–64s.CrossRefGoogle Scholar
  31. 31.
    Grover S, Balogun OD, Yamoah K, et al. Training global oncologists: addressing the global cancer control problem. Front Oncol. 2015;5:80.PubMedPubMedCentralGoogle Scholar
  32. 32.
    Dad L, Shah MM, Mutter R, et al. Why target the globe?: 4-year report (2009–2013) of the Association of Residents in Radiation Oncology Global Health Initiative. Int J Radiat Oncol Biol Phys. 2014;89(3):485–91.CrossRefGoogle Scholar
  33. 33.
    Yamoah K, Beecham K, Hegarty SE, Hyslop T, Showalter T, Yarney J. Early results of prostate cancer radiation therapy: an analysis with emphasis on research strategies to improve treatment delivery and outcomes. BMC Cancer. 2013;13:23.CrossRefGoogle Scholar
  34. 34.
    Coleman CN, Formenti SC, Williams TR, et al. The international cancer expert corps: a unique approach for sustainable cancer care in low and lower-middle income countries. Front Oncol. 2014;4:333.CrossRefGoogle Scholar
  35. 35.
    Stewart BW, Wild CP, editors. World cancer report. Geneva: WHO Press; 2014. Scholar
  36. 36.
    Suneja G, Brown D, Chang A, et al. American Brachytherapy Society: brachytherapy treatment recommendations for locally advanced cervix cancer for low-income and middle-income countries. Brachytherapy. 2017;16(1):85–94.CrossRefGoogle Scholar
  37. 37.
    Gelband H, Sankaranarayanan R, Gauvreau CL, Horton S, Anderson BO, et al. Costs, affordability, and feasibility of an essential package of cancer control interventions in low-income and middle-income countries: key messages from Disease Control Priorities, 3rd edition. Lancet. 2016;387(10033):2133–44. p. 2140.CrossRefGoogle Scholar
  38. 38.
    Global Burden of Disease Health Financing Collaborator Network. Future and potential spending on health 2015–2040: development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries. Lancet. 2017;389(10083):2005–30.CrossRefGoogle Scholar
  39. 39.
    Asante A, Price J, Hayen A, Jan S, Wiseman V. Equity in health care financing in low- and middle-income countries: a systematic review of evidence from studies using benefit and financing incidence analyses. PLoS One. 2016;11(4):e0152866.CrossRefGoogle Scholar
  40. 40.
    Jha P, Peto R. Global effects of smoking, of quitting, and of taxing tobacco. N Engl J Med. 2014;370:60–8.CrossRefGoogle Scholar
  41. 41.
    Institute for Health Metrics and Evaluation (IHME). Financing global health 2016: development assistance, public and private health spending for the pursuit of universal health coverage. Seattle: IHME; 2017.Google Scholar
  42. 42.
    GAVI. The 2016–2020 investment opportunity. Geneva; 2016.Google Scholar
  43. 43.
    Allen LN. Financing national non-communicable disease responses. Glob Health Action. 2017;10(1):1326687.CrossRefGoogle Scholar
  44. 44.
  45. 45.
    Pistenmaa D, Coleman N. Developing medical linacs for challenging regions. Int J High Energy Phys. Available at: Accessed 27 Dec 2017.

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • May Abdel-Wahab
    • 1
  • Anja Nitzsche-Bell
    • 2
  • Adam Olson
    • 3
  • Alfredo Polo
    • 4
  • Mira M. Shah
    • 5
  • Eduardo Zubizarreta
    • 6
  • Shilpen Patel
    • 7
    • 8
  1. 1.Division of Human Health, International Atomic Energy Agency – IAEA, Vienna International CentreViennaAustria
  2. 2.Resource Mobilization, IAEA Programme of Action for Cancer Therapy, International Atomic Energy Agency – IAEA, Vienna International CentreViennaAustria
  3. 3.Department of Radiation OncologyDuke University, Duke Cancer Center, Medicine CircleDurhamUSA
  4. 4.Applied Radiation Biology and Radiotherapy Section, Division of Human HealthInternational Atomic Energy Agency – IAEA, Vienna International CentreViennaAustria
  5. 5.Department of Radiation OncologyHenry Ford Health SystemDetroitUSA
  6. 6.Applied Radiation Biology and Radiotherapy Section, IAEA, Department of Nuclear Sciences and Applications, International Atomic Energy Agency – IAEAViennaAustria
  7. 7.Department of Global HealthUniversity of WashingtonSeattleUSA
  8. 8.Division of Public HealthFred Hutchinson Cancer Research CenterMenlo ParkUSA

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