Challenges and Opportunities for Increasing Adoption of Hypofractionated Radiotherapy in Low- and Middle-Income Countries

PURPOSE/OBJECTIVE(S): In the advent of the COVID-19 pandemic, professional societies including the American Society for Radiation Oncology and the National Comprehensive Cancer Network recommended increased adoption of evidence-based hypofractionated radiotherapy (HFRT), with benefits including significantly reducing the number of clinical visits for each patient to minimize potential exposure to infection, and reducing treatment costs and stress on limited workforce, particularly beneficial in Low-and-Middle-Income Countries (LMICs). Despite these benefits, HFRT adoption remains low, especially in LMICs. The purpose of this study is to investigate the challenges and opportunities for increased adoption of evidence-based HFRT in LMICs. MATERIALS/METHODS: An IRB-approved survey was implemented in 18 sample radiotherapy centers in African LMIC to assess the challenges and utilization of HFRT. The experiences of three cancer centers were documented as part of an ongoing multi-center HFRT clinical trial designed to compare results with those reported for clinical trials involving North American and European Populations. Based on the findings assessed, challenges from the survey, and recorded experiences from the three centers, an online education and training program was developed in collaboration with the Global Health Catalyst, Radiation Knowledge and computer-based training tools for treatment planning, contouring, and online learning, with remote support provided by members from the international councils of ASTRO and AAPM. RESULTS: Only 8 of 18 surveyed clinics reported adopting HFRT as a common practice. Analysis of survey data demonstrated a significant need for training on contouring for radiation oncologists, and treatment planning and quality assurance. An education and training program was developed for implementation in the LMICs via a collaborative education model involving ASTRO and AAPM members who are faculty in USA institutions in collaboration with LMIC radiation oncology professionals. CONCLUSION: The findings demonstrate a need for additional investment in infrastructure and training, as well as better ongoing education of oncology leaders on the benefits of increased adoption of evidence-based HFRT. The project also highlights opportunities and approaches for leveraging information and communication technology for collaborative high-impact global radiation oncology education, with the participation of members across both LMIC and USA institutions and professional societies. The HFRT training program provides a template for continuous education and training to increase the adoption of evidence-based approaches to HFRT that can significantly increase improved access to radiotherapy and reduce disparities in advancing globally the practice of radiation oncology. The impact of such a program and approach will be presented and discussed.