Access to diagnostic imaging and radiotherapy technologies for patients with cancer in the Baltic countries, eastern Europe, central Asia, and the Caucasus: a comprehensive analysis
Dosanjh M. Gershan V. Wendling E.C. Khader J.S. Ige T.A. Ristova M. Hugtenburg R. Georgieva P. Coleman C.N. Pistenmaa D.A. Hovhannisyan G.H. Saghatelyan T. Kazimov K. Rzayev R. Babayev G.R. Aliyev M.M. Gershkevitsh E. Khomeriki I. Petriashvili L. Topeshashvili M. Zakirova R. Rakhimova A. Karnakova N. Rakhatbek A. Kazybaev N. Bondareva O. Palskis K. Boka G. Korobeinikova E. Kudrevicius L. Apostol I. Eftodiev L.V. Rosca A. Rusnac G. Khikmatov M. Luchkovskyi S. Severyn Y. Alimov J.M. Ismailova M. Talibova S.M.
November 2024Elsevier Ltd
The Lancet Oncology
2024#25Issue 111487 - 1495 pp.
Background: Only 10–40% of patients with cancer in low-income and middle-income countries were able to access curative or palliative radiotherapy in 2015. We aimed to assess the current status of diagnostic imaging and radiotherapy services in the Baltic countries, eastern Europe, central Asia, and the Caucasus by collecting and analysing local data. Methods: This Access to Radiotherapy (ART) comprehensive analysis used data from 12 countries: the three Baltic countries (Estonia, Latvia, and Lithuania), two countries in eastern Europe (Moldova and Ukraine), four countries in central Asia (Kazakhstan, Kyrgyzstan, Tajikistan, and Uzbekistan), and three countries in the Caucasus (Armenia, Azerbaijan, and Georgia), referred to here as the ART countries. We were not able to obtain engagement from Turkmenistan. The primary outcome was to update the extent of shortfalls in the availability of diagnostic imaging and radiotherapy technologies and radiotherapy human resources for patients with cancer in former Soviet Union countries. Following the methods of previous similar studies, we developed three questionnaires—targeted towards radiation oncologists, regulatory authorities, and researchers—requesting detailed information on the availability of these resources. Authors from participating countries sent two copies of the appropriate questionnaire to each of 107 identified institutions and coordinated data collection at the national level. Questionnaires were distributed in English and Russian and responses in both languages were accepted. Two virtual meetings held on May 30 and June 1, 2022, were followed by an in-person workshop held in Almaty, Kazakhstan, in September, 2022, attended by representatives from all participating countries, to discuss and further validate the data submitted up to this point. The data were collected on a dedicated web page, developed by the International Cancer Expert Corps, and were then extracted and analysed. Findings: Data were collected between May 10 and Nov 30, 2022. 81 (76%) of the 107 institutions contacted, representing all 12 ART countries, submitted 167 completed questionnaires. The Baltic countries, which are defined as high-income countries, had more diagnostic imaging equipment and radiotherapy human resources (eg, Latvia [1·74] and Lithuania [1·47] have a much higher number of radiation oncologists per 100 000 population than the other ART countries, all of which had <1 radiation oncologist per 100 000 population) and greater radiotherapy technological capacities (higher numbers of linear accelerators and, similar to Georgia, high total external beam radiotherapy capacity) than the other ART countries, as well as high cancer detection rates (Latvia 311 cases per 100 000 population, Lithuania 292, and Estonia 288 vs, for example, 178 in Armenia, 144 in Ukraine, and 72 in Kazakhstan) and low cancer mortality-to-cancer incidence ratios (Estonia 0·43, Latvia 0·49, and Lithuania 0·48; lower than all but Kazakhstan [0·41]). The highest cancer mortality-to-cancer incidence ratios were reported by Moldova (0·71) and Georgia (0·74). Interpretation: Our findings show that the number of cancer cases, availability of diagnostic imaging equipment, radiation oncologists and radiotherapy capacity, and cancer mortality-to-cancer incidence ratios all vary substantially across the countries studied, with the three high-income, well resourced Baltic countries performing better in all metrics than the included countries in eastern Europe, central Asia, and the Caucasus. These data highlight the challenges faced by many countries in this study, and might help to justify increased investment of financial, human, and technological resources, with the aim to improve cancer treatment outcomes. Funding: US Department of Energys National Nuclear Security Administrations Office of Radiological Security.
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Department of Physics, University of Oxford, United Kingdom
International Cancer Expert Corps (ICEC), Washington, DC, United States
International Atomic Energy Agency, Vienna, Austria
King Hussein Cancer Center, Amman, Jordan
University of Abuja, Abuja, Nigeria
Faculty of Natural Sciences and Mathematics, Ss Cyril and Methodius University in Skopje, Skopje, North Macedonia
Swansea University Medical School, Swansea, United Kingdom
Swansea Bay University Health Board, Swansea, United Kingdom
SEEIIST, CERN, Switzerland
Yerevan State University, Yerevan, Armenia
National Center of Oncology, Yerevan, Armenia
National Centre of Oncology, Baku, Azerbaijan
Medical Physics Department, National Center of Oncology, Baku, Azerbaijan
Azerbaijan Regional Office of Science and Technology Center in Ukraine (STCU), Baku, Azerbaijan
Ministry of Science and Education of Azerbaijan Republic, Baku, Azerbaijan
North Estonia Medical Centre, Tallinn, Estonia
International Science and Technology Center (ISTC), Georgian Regional Officer of the Science and Technology Center in Ukraine (STCU), Tbilisi, Georgia
Georgian Technical University, Tbilisi, Georgia
Radiation Oncology Department, Todua Clinic, Tbilisi, Georgia
Center of Nuclear Medicine and Oncology, Semey, Kazakhstan
National Center of Oncology and Hematology, Ministry of Health, Bishkek, Kyrgyzstan
Department of Disease Prevention and State Sanitary and Epidemiological Surveillance of the Ministry of Health, Bishkek, Kyrgyzstan
Institute of Particle Physics and Accelerator Technologies, Riga Technical University, Riga, Latvia
Clinic of Therapeutic Radiology and Medical Physics, Riga East University Hospital—Oncology Centre of Latvia, Riga, Latvia
Oncology Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania
Public Medical Sanitary Institution, Institute of Oncology of the Ministry of Health of the Republic of Moldova, Chisinau, Moldova
STCU Information Officer, Chisinau, Moldova
ISTC Tajik Branch Office, Dushanbe, Tajikistan
National Cancer Institute, Kyiv, Ukraine
National Specialized Children Hospital OKHMATDYT, Shupik National Health University, Kyiv, Ukraine
Republican Specialized Scientific-Practical Medical Centre of Oncology and Radiology, Tashkent, Uzbekistan
Tashkent Medical Academy, Tashkent, Uzbekistan
Department of Physics
International Cancer Expert Corps (ICEC)
International Atomic Energy Agency
King Hussein Cancer Center
University of Abuja
Faculty of Natural Sciences and Mathematics
Swansea University Medical School
Swansea Bay University Health Board
SEEIIST
Yerevan State University
National Center of Oncology
National Centre of Oncology
Medical Physics Department
Azerbaijan Regional Office of Science and Technology Center in Ukraine (STCU)
Ministry of Science and Education of Azerbaijan Republic
North Estonia Medical Centre
International Science and Technology Center (ISTC)
Georgian Technical University
Radiation Oncology Department
Center of Nuclear Medicine and Oncology
National Center of Oncology and Hematology
Department of Disease Prevention and State Sanitary and Epidemiological Surveillance of the Ministry of Health
Institute of Particle Physics and Accelerator Technologies
Clinic of Therapeutic Radiology and Medical Physics
Oncology Institute
Public Medical Sanitary Institution
STCU Information Officer
ISTC Tajik Branch Office
National Cancer Institute
National Specialized Children Hospital OKHMATDYT
Republican Specialized Scientific-Practical Medical Centre of Oncology and Radiology
Tashkent Medical Academy
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