The Benefits of Providing External Beam Radiotherapy in Low- and Middle-income Countries
The Benefits of Providing External Beam Radiotherapy in Low- and Middle-income Countries
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DOI：
10.1016/j.clon.2016.11.003
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发表时间：
2017-02-01
影响因子：
3.4
通讯作者：
Barton, M.
中科院分区：
文献类型：
--
作者：
Yap, M. L.;Hanna, T. P.;Barton, M.
全球超过一半的癌症诊断发生在低收入和中等收入国家（LMIC），预计未来20年内发病率将大幅上升。放射治疗是一种重要的、具有成本效益的癌症治疗方法;但目前这些国家的放射治疗服务存在巨大缺口。本研究的目的是根据目前的循证指南，估计如果向所有需要体外放射治疗的LMIC患者提供此类治疗的潜在结局获益。通过将先前发表的癌症结局、研究和评估合作组织（CCORE）需求和结局获益估计值应用于来自GLOBOCAN 2012数据的癌症发病率和预测数据，计算了到2035年的这些获益预测估计值。所有LMIC的估计最佳放疗利用率为50%。2012年，中低收入国家约有400万癌症患者需要放射治疗。预计到2035年，这一数字将增加78%，远远高于高收入国家38%的预期增幅。各国的放射治疗效益差异很大，并受到病例组合的影响。与不使用放疗相比，如果按照指南进行放疗，所有LMIC的5年人群局部控制和生存获益估计分别为9.6%和4.4%。这相当于到2035年约有130万患者将获得局部控制益处，而如果满足中低收入国家的放射治疗需求，则超过615 000名患者将获得生存益处。潜在的结局获益在中低收入国家中更高。这些结果进一步突出表明，迫切需要缩小中低收入国家放射治疗供需之间的差距。我们必须将解决这一“无声的危机”作为优先事项，而且必须考虑到中低收入国家特有的复杂社会挑战。(C)2016年皇家放射科医师学院。由爱思唯尔有限公司出版。保留所有权利。
More than half of all cancer diagnoses worldwide occur in low- and middle-income countries (LMICs) and the incidence is projected to rise substantially within the next 20 years. Radiotherapy is a vital, cost-effective treatment for cancer; yet there is currently a huge deficit in radiotherapy services within these countries. The aim of this study was to estimate the potential outcome benefits if external beam radiotherapy was provided to all patients requiring such treatment in LMICs, according to the current evidence-based guidelines. Projected estimates of these benefits were calculated to 2035, obtained by applying the previously published Collaboration for Cancer Outcomes, Research and Evaluation (CCORE) demand and outcome benefit estimates to cancer incidence and projection data from the GLOBOCAN 2012 data. The estimated optimal radiotherapy utilisation rate for all LMICs was 50%. There were about 4.0 million cancer patients in LMICs who required radiotherapy in 2012. This number is projected to increase by 78% by 2035, a far steeper increase than the 38% increase expected in high-income countries. National radiotherapy benefits varied widely, and were influenced by case mix. The 5 year population local control and survival benefits for all LMICs, if radiotherapy was delivered according to guidelines, were estimated to be 9.6% and 4.4%, respectively, compared with no radiotherapy use. This equates to about 1.3 million patients who would derive a local control benefit in 2035, whereas over 615 000 patients would derive a survival benefit if the demand for radiotherapy in LMICs was met. The potential outcome benefits were found to be higher in LMICs. These results further highlight the urgent need to reduce the gap between the supply of, and demand for, radiotherapy in LMICs. We must attempt to address this 'silent crisis' as a matter of priority and the approach must consider the complex societal challenges unique to LMICs. (C) 2016 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.