Rescuing Spanish Radiation Therapy: The Role of Leadership and Opportunity (original) (raw)
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Challenges of Radiation Oncology in Spain Today
Reports of Practical Oncology & Radiotherapy, 2013
The increasing cost of health care delivery, coupled with reduced investments and budget cuts in European health care systems, has had a severe negative impact on health care delivery in Spain. This reduction in spending has had particularly negative effects on specialties that are heavily reliant on large capital investments to purchase the latest technologies needed to deliver optimal radiotherapy treatments. The Spanish Society of Radiation Oncology has been proactively working to mitigate the negative impact of budget cuts in Spain. In this paper, the authors describe a variety of solutions and proposals to overcome these challenges.
Are there enough radiation oncologists to lead the new Spanish radiotherapy?
Clinical and Translational Oncology, 2019
Aim Radiation oncology services in Spain are undergoing a process of technical modernization, but-in a context of increasing demand by an ageing population-it is unclear whether there are enough radiation oncologists to staff the newly equipped units. This study aims to assess the number of specialists working in radiation oncology services in Spain relative to current and future needs. Materials and methods In the second half of 2017, the Commission on Infrastructures of the Spanish Society for Radiation Oncology (SEOR) sent a questionnaire on radiation oncology staff to the heads of all 122 public (n = 76, 62%) and private (n = 46, 38%) radiation oncology services in Spain. Data collected were the number of professionals, their position, and their year of birth for specialists and residents in each service. In the descriptive analysis, for continuous variables we calculated means, standard deviations and ranges for each Spanish region and work post. For qualitative variables, we constructed frequency tables. All analyses were performed with R statistical software, version 3.5.1. Results The survey response rate was 100% among service heads across all 122 centers. The total number of radiation oncologists working in these centers is 721, or 15.4 per million population, with considerable variations between regions. Given the national recommendations to have 20 radiation oncologists per million population, there is currently a deficit of 204 specialists. If the 163 upcoming retirements are also taken into account, there will be 367 fewer radiation oncologists than required to meet the 25% increase in indications for radiotherapy projected for 2025. Conclusions The classic model for calculating staff needs based on the number of treatments is outdated, and recommendations should be revised to reflect the current reality. A new model should integrate the most complex technological advances and emerging plans in radiotherapy, without neglecting the other activities carried out in radiation oncology services that are not directly linked to patient care.
Infrastructure of radiotherapy in Spain: A minimal standard of radiotherapy resources
International Journal of Radiation Oncology*Biology*Physics, 2003
Purpose: To assess the state of our specialty, the Spanish Society of Radiotherapy and Oncology ordered a survey of all Spanish services of radiation oncology. Methods and Materials: In June 1999, the Society ordered an analysis of the state of radiation oncology. It created a survey that was sent to all radiotherapy units in Spain. A database was created in which 230 variables were analyzed. Results: Eighty-four centers were analyzed, and 157 external beam irradiation, megavoltage units were counted, of which 67 were cobalt units and 90 were linear accelerators. The cobalt units worked an average of 11.4 h daily and the linear accelerators 11.6 h. The number of patients/unit/y was 472 for the cobalt units and 442 for the linear accelerators. The number of patients by physician and year was 179. Each center received a mean of 958 new patients annually. The average between the reception and start of treatment was 25.52 days (maximum 60), and it was estimated that only 38.1% of cancers were irradiated. The number of radiation oncologists working was 392. Spain has a deficit of 297 radiation oncologists. Conclusion: There is a need for 44 MV units and for the replacement of 67 cobalt units. The present lack of units has had an impact on palliative treatment, which has resulted in pharmacy costs. As long as these instrumental deficiencies are not solved, waiting lists will continue to be inherent to the system. There are also important staff deficiencies, in that about 297 radiation oncologists would be needed to cover the needs.
History of the development of radiotherapy in Latin America
Ecancermedicalscience, 2017
Radiotherapy was the first nonsurgical treatment for malignant tumours and represents one of the oldest disciplines of oncology. In Latin America, as in many parts of the world, the history of modern oncology begins with the implementation of radiation therapy facilities. The development of radiotherapy in Latin America was possible thanks to the seminal work of radiation oncologists in different countries. As a large territory, there is a need to implement modern facilities and equipment, but unfortunately there are disparities in the access and quality of radiotherapy services across Latin America and even within individual countries. In this review, we describe the history, challenges and success in the implementation of radiotherapy and the frustration caused by the lack of facilities in several Latin American countries.
The White Book of Radiation Oncology in Spain
Clinical and Translational Oncology, 2011
The White Book of Radiation Oncology provides a comprehensive overview of the current state of the speciality of radiation oncology in Spain and is intended to be used as a reference for physicians, health care administrators and hospital managers. The present paper summarises the most relevant aspects of the book's 13 chapters in order to bring the message to a wider audience. Among the topics discussed are the epidemiology of cancer in Spain, the role of the radiation oncologist in cancer care, human and material resource needs, new technologies, training of specialists, clinical and cost management, clinical practice, quality control, radiological protection, ethics, relevant legislation, research & development, the history of radiation oncology in Spain and the origins of the Spanish Society of Radiation Oncology (SEOR).
Status of Radiation Therapy in Uruguay: Past, Present, and Future
International Journal of Radiation Oncology*Biology*Physics, 2016
Uruguay is a small country of rolling hills and mild climate located on the east coast of South America, bordering the Atlantic Ocean, between Argentina and Brazil (Fig. 1). It has a surface equivalent to the state of Florida, but with a population of only 3.3 million. Cancer in Uruguay is the second highest cause of death, second only to heart disease, despite this country's rich history in advancements and developments for the fight against cancer (1, 2). Uruguay is one of the few countries in Latin America where the entire population has access to free education, from primary school through graduate school, contributing to the country's high levels of literacy (98.5%). Most of the population comprises descendants of Spanish and Italian immigrants, because most of the native Indians were virtually exterminated by the Spaniard conquistadores in the process of colonization. The capital city, Montevideo, has more than 1.7 million inhabitants (2014 estimate). Uruguay's free market economy is characterized by an export-oriented agricultural sector, a well-educated workforce, and high levels of social spending: the Uruguayan government spends 8.8% of its gross domestic product in health care expenditures, 61st in the world. There are 3.74 physicians per 1000 inhabitants (3).
Reports of Practical Oncology & Radiotherapy, 2020
Aim: Describe the results of the first national census of radiotherapy in Mexico in order to make a situational diagnosis of radiotherapy availability, offer more accurate information to radiation oncologists, and promote an adequate scientific based investment for the country. Background: According to the Organisation for Economic Cooperation and Development (OECD), the density of radiotherapy (RT) machines per million habitants in Mexico is approximately 1.7−1.8. Other international organizations such as DIRAC-IAEA report 1.15 per million habitants. National organizations collect data indirectly and previous surveys had a low accrual rate (32.5%). Therefore, a precise census is required. Material and methods: The Mexican Radiation Oncology Certification Board (CMRO for its acronym in Spanish) conducted a nationwide census from January through November 2019. Gathered information was combined with CMRO database for sociodemographic information and human resources. Results: The study included 103 RT centers [95.1% answered the survey], with a median of 2 centers by state (ranging from 0 in Tlaxcala to 20 in Mexico City) and with a report of only 1 center in 11 states (34.4%). Fifty-six (54.3%) of the centers are public. Fourteen centers (13.6%) have residency-training programs. The total number of RT machines is 162 [141 clinical and linear accelerators (87%) and 21 radionuclide units (13%)] with a median of 3 machines by state (0 in Tlaxcala to 46 in Mexico City) and with ≤3 machines in 18 states (56.25%). The overall calculated density of RT machines per million habitants is 1.32, varying from 0 in Tlaxcala to 5.16 in Mexico City. The density of linear and clinical accelerators per million population is 1.19. The total number of brachytherapy units is 66, with a median of 1 center with brachytherapy unit per state and 29 states with ≤3 centers with a brachytherapy unit (90.6%). Thirty-seven brachytherapy units (56.1%) have automated afterload high-dose rate. The overall rate of brachytherapy units per million inhabitants is 0.55, varying from 0 in 5 states (15.6%), 0.1-0.49 in 8 states (25%), 0.5-0.99 in 13 states (40.6%), 1-1.49 in 5 states (15.6%) and 1.5-1.99 in Mexico City (3.1%). The Mexican CMRO has 368 radiation oncologists certified (99 women and 269 men), of whom only 346 remain as an active part of Mexico's workforce. Conclusions: This is the first time the CMRO conducts a national census for a radiotherapy diagnostic situation in Mexico. The country currently holds a density of clinical and linear accelerators of 1.19 per million habitants. Brachytherapy density is 0.55 devices per million habitants, and 57% of radiotherapy centers have brachytherapy units.
Perspectives on Patient Access to Radiation Oncology Services in South America
Seminars in Radiation Oncology, 2017
Cancer represents a fast-growing challenge worldwide, and is being recognized as an emerging and critical issue in low and middle-income countries, such most of South America. This subcontinent is unique for its geography, culture and ethnical diversity. Most of its countries have large expanses of jungle and desert where underserved populations including indigenous (native Indians), represent a challenge for cancer care. Many indigent patients have no access to preventive care nor early diagnosis. This results in late presentations with advanced disease and frequently incurable cancer. Prompt and coordinated action from local and international organizations is needed to support and guide local governments to avoid a global crisis. The critical role of education to improve awareness of the importance of radiation therapy, a costeffective treatment modality, with the potential to help these patients at a relatively low cost is discussed.