'Access to Radiotherapy for Cancer treatment (ARC) Project': Guidance for low and middle-income countries establishing safe and sustainable radiotherapy services
- Publication Type:
- Thesis
- Issue Date:
- 2020
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๐๐ป๐๐ฟ๐ผ๐ฑ๐๐ฐ๐๐ถ๐ผ๐ป: Efforts to improve access to cancer care, including radiotherapy services in low and middle-income countries (LMICs) is challenging. Many radiotherapy initiatives in LMICs have failed to fully deliver on their promise because of multi-faceted barriers at the systems, organisational and patient levels, leading to significant wastage of scarce resources. Greater guidance on how to assess and build LMICsโ readiness for establishing sustainable radiotherapy services is needed to improve cancer care outcomes in LMICs.
๐๐ถ๐บ: The โ๐ccess to ๐ฅadiotherapy for ๐ancer treatment (ARC) Projectโ aimed to provide practical guidance to LMICs on establishing safe and sustainable radiotherapy services.
๐ ๐ฒ๐๐ต๐ผ๐ฑ๐: The mixed qualitative methods ARC Project involved a: systematic review; and two-part qualitative study. The systematic review synthesised strategies adopted by LMICs to improve access to cancer treatment and palliative care. Semi-structured interviews undertaken with global radiotherapy experts explored perceived facilitators and barriers to establishing sustainable radiotherapy services in LMICs. The mid-point meta-inference of the systematic review and semi-structured interview data generated a draft list of requirements, which was circulated to global experts during the second part-of the qualitative study. The final meta-inference was undertaken following the completion of the three studies.
๐๐ถ๐ป๐ฑ๐ถ๐ป๐ด๐: The systematic review identified that comparatively few studies have focused specifically on improving radiotherapy in LMICs, with no research evaluating effectiveness. The semi-structured interviews identified three key facilitators to establishing sustainable radiotherapy services in LMICs, namely: committing to a vision of improving cancer care; making it happen and sustaining a safe service; and leveraging off radiotherapy to strengthen integrated cancer care. The mid-point meta-inference generated 42 potential requirements, which were organised into four readiness domains: commitment (n=13); cooperation (n=7); capacity (n=17); and catalyst (n=5). The participant validation confirmed 37 of the generated requirements as relevant for inclusion in a radiotherapy service development readiness self-assessment guide for use by LMICs.
The end-point meta-inference of the ARC Projectโs integrated data presented the โ๐ฅ๐adiness ๐ฆ๐lf-๐ssessment (RESEA) Guideโ, with 120 questions that may help LMICs at macro and meso level to determine and create action plans to improve their readiness to establish radiotherapy services.
๐๐ผ๐ป๐ฐ๐น๐๐๐ถ๐ผ๐ป๐: The ARC Project has identified a complex combination of facilitators and barriers that influence the establishment of sustainable radiotherapy services in LMICs. It has developed a RESEA Guide to provide support for LMICs seeking to establish sustainable radiotherapy services. Further work is needed to evaluate the acceptability and feasibility of the RESEA Guide and inform further refinements.
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