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Kavuma A, Kibudde S, Schmidt M, Zhao T, Gay H, Li B, Michalski J, Hugo G, Vanchinbazar E, Minjgee M, Nansalmaa E, Ssewamala F, Velarde A, De Fella V, Ixquiac M, Henke L, van Rheenen J, Sun B. Remote Global Radiation Oncology Education and Training: A Pathway to Increase Access to High-Quality Radiation Therapy Services in Low- and Middle-Income Countries. Adv Radiat Oncol 2023; 8:101180. [PMID: 36846439 PMCID: PMC9947225 DOI: 10.1016/j.adro.2023.101180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/05/2023] [Indexed: 01/19/2023] Open
Abstract
Purpose There is a vital need to train radiation therapy professionals in low- and middle-income countries (LMICs) to develop sustainable cancer treatment capacity and infrastructure. LMICs have started to introduce intensity modulated radiation therapy (IMRT), which is the standard of care in high-income countries, because of improved outcomes and reduced toxicities. This work reports the efficacy of a complementary asynchronous plus synchronous virtual-training approach on improving radiation therapy professions' self-confidence levels and evaluating participants' attitudes toward asynchronous and synchronous didactic hands-on learning in 3 LMICs. Methods and Materials Training was provided to 37 participants from Uganda, Guatemala, and Mongolia, which included 4 theoretical lectures, 4 hands-on sessions, and 8 self-guided online videos. The 36-day training focused on IMRT contouring, site-specific target/organ definition, planning/optimization, and quality assurance. Participants completed pre- and postsession confidence surveys on a 0 to 10 scale, which was converted to a 5-point Likert rating scale to evaluate the training outcomes. The pros and cons of the 3 different training formats were compared. Results The participants included 15 (40.5%) radiation oncologists, 11 (29.7%) medical physicists, 6 (16.2%) radiation therapists, and 5 (13.5%) dosimetrists. Approximately 50% had more than 10 years of radiation therapy experience, 70.8% had no formal IMRT training, and only 25% had IMRT at their institutions. The average experience and confidence levels in using IMRT at baseline were 3.2 and 2.9, which increased to 5.2 and 4.9 (P < .001) after the theoretical training. After the hands-on training, the experience and confidence levels further improved to 5.4 and 5.5 (P < .001). After the self-guided training, the confidence levels increased further to 6.9 (P < .01). Among the 3 different training sessions, hands-on trainings (58.3%) were most helpful for the development of participants' IMRT skills, followed by theoretical sessions with 25%. Conclusions After completing the training sessions, Uganda and Mongolia started IMRT treatments. Remote training provides an excellent and feasible e-learning platform to train radiation therapy professionals in LMICs. The training program improved the IMRT confidence levels and treatment delivery. The hands-on trainings were most preferred.
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Affiliation(s)
- Awusi Kavuma
- Department of Radiation Therapy, Uganda Cancer Institute, Kampala, Uganda
- Corresponding author: Awusi Kavuma, DPhil
| | - Solomon Kibudde
- Department of Radiation Therapy, Uganda Cancer Institute, Kampala, Uganda
| | - Matthew Schmidt
- Department of Radiation Oncology, School of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Tianyu Zhao
- Department of Radiation Oncology, School of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Hiram Gay
- Department of Radiation Oncology, School of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | | | - Jeff Michalski
- Department of Radiation Oncology, School of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Geoffrey Hugo
- Department of Radiation Oncology, School of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | | | | | | | - Fred Ssewamala
- Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Angel Velarde
- Perelman School of Medicine, University of Pennsylvania & Center for Global Health, Philadelphia, Pennsylvania
| | - Vicky De Fella
- Liga Nacional Contra el Cancer/Instituto de Cancerologia, Guatemala City, Guatemala
| | - Milton Ixquiac
- Liga Nacional Contra el Cancer/Instituto de Cancerologia, Guatemala City, Guatemala
| | - Lauren Henke
- Liga Nacional Contra el Cancer/Instituto de Cancerologia, Guatemala City, Guatemala
| | - Jacaranda van Rheenen
- Global Health Center, Institute for Public Health, Washington University in St. Louis, St. Louis, Missouri
| | - Baozhou Sun
- Department of Radiation Oncology, School of Medicine, Washington University in St. Louis, St. Louis, Missouri
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Bhatia R, Lichter KE, Gurram L, MacDuffie E, Lombe D, Sarria GR, Grover S. The state of gynecologic radiation therapy in low- and middle-income countries. Int J Gynecol Cancer 2022; 32:421-428. [PMID: 35256432 PMCID: PMC10042220 DOI: 10.1136/ijgc-2021-002470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 12/14/2021] [Indexed: 02/04/2023] Open
Abstract
A disproportionate burden of gynecologic malignancies occurs in low- and middle-income countries. Radiation therapy is an integral component of treatment for gynecologic malignancies both from a curative (locally advanced cervical cancer) and palliative (bleeding cervical or pelvic mass) standpoint. Critical to understanding how better to serve patients in this regard is understanding both the extent of disease epidemiology and the radiotherapy infrastructure to treat these diseases. In this review, we explore various geographic regions and how they address a unique set of challenges specific to the peoples and culture of the region. We identify common threads across regions, including sparse distribution of radiation equipment, geographic access, and specialized training. We also highlight examples of success in the use of telemedicine and cross-cultural partnerships to help bolster access to training to ensure increased access to adequate and appropriate treatment of gynecologic malignancies.
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Affiliation(s)
- Rohini Bhatia
- Department of Radiation Oncology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Katie E Lichter
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California, USA
| | - Lavanya Gurram
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Emily MacDuffie
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Dorothy Lombe
- Department of Oncology, Cancer Diseases Hospital, Lusaka, Zambia
| | - Gustavo R Sarria
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Nordrhein-Westfalen, Germany
| | - Surbhi Grover
- Department of Radiation Oncology, Botswana-University of Pennsylvania Partnership, Philadelphia, Pennsylvania, USA .,University of Pennsylvania, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Hassan S, Oar A, Ward I, Koh ES, Shakespeare TP, Yap ML. Equity should know no borders: The role of Australasian radiation oncologists in supporting radiation oncology services in low- and middle-income countries in the Asia-Pacific. J Med Imaging Radiat Oncol 2021; 65:410-417. [PMID: 33973359 DOI: 10.1111/1754-9485.13191] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 04/20/2021] [Indexed: 12/17/2022]
Abstract
The rapid rise in cancer incidence within the world's poorest nations highlights the need for equitable access to evidence-based cancer care. It has been previously demonstrated that radiotherapy is a cost-effective and necessary tool in cancer treatment. However, globally there is a growing divide between demand and supply of radiotherapy services. In low- and middle-income countries, this resource gap is particularly problematic. By region, the Asia-Pacific has been demonstrated to have the highest absolute deficit in radiotherapy services. Radiation oncologists in Australia and New Zealand are geographically well positioned to assist departments within the Asia-Pacific to help to reduce these inequities. The Asia-Pacific Radiation Oncology Special Interest Group (APROSIG) aims to support oncology professionals in the Asia-Pacific to develop safe and sustainable cancer services. Members have already contributed to multiple projects throughout the region, supported by grants and departmental funding. However, the backbone of support comes from volunteers sharing their time and expertise. The Australasian oncological community has the skills and knowledge to help not only those within our borders but also beyond. Such efforts provide the potential to develop valuable clinical, educational, research and leadership experiences whilst establishing networking opportunities throughout the most populated regions of the world. More options for growth and work in global health must be investigated, encouraging future trainees to consider a role within the global cancer community. Without prompt and continued action, the resource deficit is likely to grow and the inequity in accessing radiotherapy and other cancer services further magnified.
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Affiliation(s)
- Sean Hassan
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Andrew Oar
- Icon Cancer Centre, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Iain Ward
- Canterbury Regional Cancer and Haematology Service, Christchurch Hospital, Christchurch, New Zealand
| | - Eng-Siew Koh
- University of New South Wales, Sydney, New South Wales, Australia.,Collaboration for Cancer Outcomes, Research and Evaluation, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Thomas P Shakespeare
- University of New South Wales, Sydney, New South Wales, Australia.,Mid North Coast Cancer Institute, Coffs Harbour, New South Wales, Australia
| | - Mei Ling Yap
- University of New South Wales, Sydney, New South Wales, Australia.,Collaboration for Cancer Outcomes, Research and Evaluation, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, Sydney, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia.,Macarthur Cancer Therapy Centre, Western Sydney University, Campbelltown, New South Wales, Australia
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