Breast, head and neck, lung and cervical cancer account for 60 per cent of India’s radiotherapy needs, says the study.
A recent
ICMR study has highlighted a substantial shortfall in radiotherapy utilisation
across all cancer types and underscored the need for interventions to meet the
gap in machines required for equitable cancer care.
Published
in the BMC Cancer journal, the study stated that 28.5 per cent of cancer
patients receive radiotherapy, which is lower than the estimated optimal rate
of 58.4 per cent.
Breast, head and neck, lung and
cervical cancer account for 60 per cent of India’s radiotherapy needs, it said.
Data from the Australian Collaboration for Cancer Outcomes Research
and Evaluation (CCORE) were used by the researchers of ICMR-National Centre for
Disease Informatics and Research, Bengaluru, for conducting the study.
Epidemiological data on stage,
subsite and histology from the National Cancer Registry Programme were used to
assess the optimal utilisation proportion for India. A sensitivity analysis was
carried out.
Similarly, the optimal radiotherapy fraction has also been
calculated. These measures have been used to estimate the existing radiotherapy
utilisation gap by comparing with the current radiotherapy utilisation from the
cancer registry as well as to estimate the optimal radiotherapy machines
required for the country.
“This study provides a
comprehensive assessment of radiotherapy demand and existing gaps in
radiotherapy utilisation and in the number of machines in India based on an
epidemiological analysis of the cancer burden from the National Cancer Registry
Programme. Our analysis shows that approximately 58 per cent of all cancer
cases in India should ideally receive radiotherapy based on clinical
indications.
“However, the current
radiotherapy utilisation in India is only 28.5 per cent, which is less than
half of the required level,” the researchers said.
The study also recommended that
India would require 1,585 to 2,545 machines, which may increase to a range of
2,016 to 2,291 external beam radiotherapy machines if the assumptions from
previous benchmark studies are followed.
The burden of four cancer
sites—breast, head and neck, lung and cervical cancer—constitutes around 60 per
cent of the total radiotherapy requirement for cancer care in India, the study
said.
This
points towards an increasing demand for radiotherapy in the coming years as
there is expected to be a 70-100 per cent increase in breast, head and neck and
lung cancer in low and middle income countries (LMIC). Radiotherapy utilisation
of most cancer sites is lower compared to optimal radiotherapy utilisation.
Among the
major indicated cancer sites, the deficit is more prominent in lymphoma and
lung cancer (relative deficit of more than 70 per cent), followed by prostate,
breast and oesophagus, it said.
The study mentioned that India
accounts for 7 per cent of global cancer incidence, ranking third after China
and the USA. By the end of 2025, the incidence of cancer in India is projected
to reach 1.57 million cases, posing a significant public health challenge.
As the fifth leading cause of
death in the country, cancer demands urgent attention to improve prevention,
diagnosis and treatment, it said.
Radiotherapy, a cornerstone of
cancer treatment, plays a crucial role in controlling tumour growth, reducing
tumour size pre-surgery, and alleviating pain in advanced stages.
However, its availability in low
and middle-income countries like India remains insufficient due to high setup
and operational costs, creating a significant gap between demand and resources.
The World Health Organization
(WHO) recommends a minimum of one radiotherapy machine (external radiotherapy
machine) per million population, with an optimal target of four per million,
the study stated.
For India’s projected population
of 1.45 billion in 2025, this translates to a need for a minimum of 1,450
machines. Yet, only 794 megavoltage (MV) machines are currently available. The
shortfall is about 45 per cent from the minimal required standard, the study
said.
The study highlighted that in
India, greater investment is needed to expand radiotherapy facilities to meet
the growing demands of cancer patients.
“Aside from increasing the number
of equipment, addressing the inequitable distribution of radiotherapy services
is also crucial. To align with the country’s cancer burden and ongoing cancer
control efforts, India must meet evidence-based targets for radiotherapy
machine availability.
“As a part of this, India is also
ramping up efforts to develop and deploy affordable indigenous radiotherapy
machines to improve access and reduce dependence on costly imports,” the study
stated.
Furthermore, a detailed
situational study of radiation equipment deployment with its features and
complexity, utilisation and throughput is required for informed planning and
policymaking. Cancer screening and early detection programmes can facilitate
the diagnosis of cancers at earlier stages. This could reduce the required
quantum of radiotherapy shortly and thus, improve the overall survival of
patients, the study said.
The cancer registry data informs
the policy-makers to identify gaps in radiotherapy access, assess resource
needs and guide decisions to ensure equitable and effective cancer care
delivery.
Optimal
radiotherapy utilisation (RTU) calculated for India was higher than optimal
radiotherapy utilisation estimation done for developed countries like 48·3 per
cent for Australia and 51 per cent for European countries, the study said.
The optimal RTU calculation for
middle income countries also has an average optimal radiotherapy utilisation
value of 52 per cent ranging from 47 to 56 per cent.
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