Virtually every aspect of healthcare has been affected by the coronavirus pandemic, and cancer care is no exception. Whereas the current crisis requires cancer care professionals to adapt the way they provide services, it also offers opportunities to fast-track innovation and forge new partnerships, panellists agreed at a high-level virtual roundtable on the role of radiotherapy in cancer control at this week's World Health Summit in Berlin.
"Thanks to recent technological advances, radiotherapy is now more precise and effective than ever before, with fewer side effects and less time needed for delivery," said IAEA Director General Rafael Mariano Grossi at the event co-convened by the IAEA and Varian Medical Systems, a US-based radiation oncology treatments and software company. Mr Grossi noted that despite these advances, one country in four does not have access to radiotherapy services, and nearly half of the countries in Africa are without a single radiotherapy machine.
Ruiz Gómez, Minister of Health and Social Protection of Colombia, described the cancer burden in Latin America and highlighted that mortality has fallen for various major cancers in Colombia. "This reflects the success of our universal health insurance coverage that offers early cancer detection and treatment to all of our citizens." With help of the IAEA's technical cooperation programme, Colombia has also expanded its nuclear medicine and radiotherapy services, but needs remain. "Within the next decade, we expect that numbers of new cancer cases to increase by almost 50 per cent. This is a big challenge, and we need to grow our capacities very rapidly to cope with the disease," Gómez stated.
The panel, composed of high-level government officials as well stakeholders from the private sector and leading clinical experts, highlighted access to quality cervical cancer treatment as a particular concern. This highly preventable and curable disease kills more than 300,000 women every year, with 90 per cent of them living in low- and middle-income countries. This major inequality has recently led to a historic commitment of the global community. "Just this summer, we saw the adoption of the World Health Organization's (WHO) global strategy towards the elimination of cervical cancer, with a focus on coverage and equity of access through reaching ambitious targets for scaling up prevention, diagnosis, treatment and palliative care by 2030, which is a huge step forward," said Julie Torode, Director of Special Projects of the Union for International Cancer Control (UICC).
This WHO strategy includes the aim of providing 90 per cent of women with cervical cancer with quality treatment and care. The IAEA plays a major role in supporting countries to make headway on this agenda. "We can make a difference with increased access to radiotherapy," Mr Grossi said.
Supriya Chopra, Professor for Radiation Oncology at the Tata Memorial Center in India, added that brachytherapy and internal radiation therapy were the only available cure for women with invasive cervical cancer and that funding their expansion was good investment. "Costs can be recovered in two or three years when looking at the lives of women saved and their contribution to the economy," she said. Brachytherapy is a type of internal radiotherapy that gives radiation from inside the body - a radioactive source is put close to or inside the tumour to destroy cancer cells, while sparing healthy, surrounding tissue.
Delivering radiotherapy and innovation during the pandemic
The unfolding pandemic has jeopardized many advances already made in global cancer control. Numerous reports show that COVID-19 has caused major disruptions to cancer care - from the suspension of screening services to delays in treatment and palliation. However, radiotherapy services have shown to be less prone to disruption as they are conducted in an out-patient setting and can continue to be provided with proper control measures in place.
Bello Abubakar Mohammed, President of the African Organisation for Research and Training in Cancer (AORTIC) and clinical oncologist in Nigeria, said: "We have seen that radiotherapy can comfortably and safely be administered at the time of COVID, and we have not closed any of our facilities." He also highlighted the importance of implementing all necessary precautions and preventative measures, "especially for the patients, considering the fact that most cancer patients tend to be more vulnerable to the coronavirus."
The pandemic has also shown to be a driver for a faster uptake of innovative technology and techniques. The use of telemedicine for consulting patients, tumour board meetings and treatment planning has greatly expanded. Cloud-based and remote systems allow effective care to be delivered with fewer onsite personnel requirements and reduced onsite space requirements. "This whole realm of telehealth is very important," said Dow Wilson, Chief Executive Officer at Varian Medical Systems. "We have thousands of institutions worldwide delivering cancer care very successfully in the pandemic. One of the things that COVID-19 has done is that it has, in fact, accelerated the adoption of telehealth."
Strengthening cross-sector cooperation to improve patient outcomes
Sanowar Hossain, Chairman of the Bangladesh Atomic Energy Commission highlighted the need for collaborative action between the private sector, civil society and international organizations. "With the assistance of the IAEA, we have trained hundreds of medical physicists, radiation oncologists, radiotherapy technologists and other technical staff over the past few years, and we have now 57 centres with radiotherapy facilities." However, he added that stronger collaboration with other partners is needed. "Only if we collaborate with international bodies along with government and NGOs, can we tackle this alarming situation and effectively manage the cancer patients in our country."
Mr Grossi acknowledged the diverse coalition of partners that has already joined global efforts to reduce the cancer burden, including the private sector, and advocated for enhanced and new, innovative collaborations. "We know where the problems lie, and we know what is needed. What we need to do is to multiply our partnerships and move them to a higher level," he said during his closing remarks. "There is a lot to be done. Let's roll up our sleeves and get on with the work."
The panellists who took part in the session were Rafael Mariano Grossi, IAEA Director General; Ruiz Gómez, Minister of Health and Social Protection of Colombia; Dow Wilson, Chief Executive Officer at Varian Medical Systems; Sanowar Hossain Chairman of the Bangladesh Atomic Energy Commission; Supriya Chopra, Professor for Radiation Oncology at the Tata Memorial Center in India; Bello Abubakar Mohammed, President of the African Organisation for Research and Training in Cancer (AORTIC); and Francisco Osvaldo García Pérez, Head of Nuclear Medicine and Molecular Imaging Department, National Cancer Institute, Mexico. The session was chaired by Julie Torode, Deputy CEO and Director of Advocacy and Networks, Union for International Cancer Control (UICC), and Anja Nitzsche, Head of Resource Mobilisation at the IAEA.
Panellists took part virtually in the World Health Summit session. (Photo: WHS)
