Radiation Therapy Current Practice Capacity and Needs Assessment in Africa

Purpose/Objective(s): There is a documented disparity in the distribution of radiotherapy (RT) services and professionals to address the cancer care needs across the continent of Africa. To further understand the current treatment landscape, we developed a survey to assess radiation oncology training, equipment, resources, and future needs. Materials/Methods: At the 2017 African Organization for Research & Training in Cancer (AORTIC) International Meeting in Kigali, Rwanda, a 37 question survey was distributed to radiation oncologists (RO), medical physicists (MP), and radiation therapy technologists (RTTs) in attendance to identify current capacity and challenges to providing cancer care. Paper surveys were available and an electronic link to completing the survey was distributed after the meeting. The survey was divided into 4 sections including: 1) Demographics and Training 2) Current Practice Capacity, 3) Future Needs, and 4) Case Vignettes. Results: A total of 24 completed surveys, representing 11 countries (Ethiopia, Ghana, Kenya, Nigeria, Uganda, Sierra Leone, South Africa, Sudan, Tunisia, Zambia, and Zimbabwe) and 15 cancer treatment centers across Africa, were analyzed. The majority of respondents were radiation oncologists (19/24, 76%) a third of whom have been in practice for \u3e10 years (6/19). The majority received training in cobalt RT (14/19, 58.3%), 3D conformal RT (14/19, 58.3%) and brachytherapy (13/19, 54.2%). Four percent (n=1) were trained in SBRT, proton, or rapid arc therapy. Current practice capacity was assessed among the 15 unique cancer treatment centers. The median number of ROs, MPs and RTTs at the centers was 6 (interquartile range [IQR] 2.5 – 6.5), 3 (IQR 2-4), and 8 (IQR 4-10), respectively. The median number of patients treated on a daily basis was 60 (IQR 50-100). The majority (10/15, 66.7%) of centers had a diagnostic CT scanner, 7/15 (46.7%) had a cobalt external beam treatment machine and 9/15 (60.0%) had a linear accelerator. The most common cancers seen at their centers as identified by participants were cervical (24/24, 100%), breast (23/24, 95.8%), and prostate (15/24, 62.5%). For future needs, the majority of respondents believed that new machinery, an exchange program with overseas institutions, or access to educational resources would be beneficial (n=15, 65%). Specifically, over half of respondents requested training in intensity modulated RT (IMRT) (15/24, 62.5%), image guided RT (IGRT) (15/24, 62.5%), and 3D-conformal RT (14/24, 58.3%)). Conclusion: Of the surveyed respondents at the AORTIC international meeting in 2017, radiation centers reported a heavy patient load and comfort with treatment techniques in cobalt/3D-confromal RT. Most centers have a linear accelerator and are interested in further training in IMRT and IGRT. Future collaborations that assist with new machinery and international exchange programs are needs identified by cancer centers to best manage their current cancer burden