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The sustainability of radiotherapy services in Asia: How does FARO contribute to it?

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Cancer has been a common disease in recent years. In 2030, the incidence and mortality of cancer will rise to 21.6 million new cases and 13 million deaths. Asia, representing 60% of the world population, is a highly diverse continent with different income countries (ranging from low to high income). In regards to radiotherapy (RT) services, based on the latest 2018 radiotherapy survey among FARO countries, we can see that most countries (58%) seem to have a good ratio of RT services (1 MV per 1 million population, based on International Atomic Energy Agency/IAEA standard).

However, if we look into cancer incidence data and the proportion of radiotherapy equipment and the incidence of cancer (adjusted to 24 fractions/course and 9600 fractions per year for 1 MV), we can see that only two countries who fulfilled the RT machines needed in their countries. By comparing these two types of data, we can see that there is the discrepancy in the coverage of radiotherapy, especially on using the most reliable data. Moreover, based on the data from Global Task Force on Radiotherapy for Cancer Control (GTFRCC), coverage of RT in low-middle income countries (LMIC) was far from the needs, but having a high incidence, upper-middle and high-income countries’ coverage of RT are also not fully covered. Nevertheless, funding is an essential part of sustaining and developing radiotherapy in the world. Globally, cancer consumes approximately 5% of the national health expenditure and radiotherapy absorbs 5% of the total cancer cost. A country with high Gross National Income (GNI) per capita has a high health expenditure and better capacity to build a good healthcare system.

On the other hand, in LMICs, lack of income leads to lower health expenditure and inadequate health facilities. As radiotherapy only form approximately 0.25% of the total health budget, added by the growth of cancer incidence, the universal coverage of radiotherapy in LMIC is yet to be solved. Federation of Asian Organizations for Radiation Oncology (FARO), as a federation which comprises of radiation oncology societies in Asia, aims to foster the role of radiation oncology to improve the basic level of radiotherapy in the Asian region. Role of FARO can be reflected from its purposes to promote cooperation and communication, develop the standard of education/training and research, promote advancement in status and standard of practice, organize international conferences/meetings/courses and collaborate with other scientific or professional global organizations. By having FARO, added by the role of the cancer control program, countries in Asia can improve RT services to the next level for patients’ purposes. In conclusion, there is a huge variation among RT needs in Asian countries. However, the discrepancy in cancer incidence is needed to be verified. Moreover, funding is an essential part for the sustainability of RT services. To overcome those problems, FARO, as an organization, should work together with the national cancer control program of each country to form a better root for a better radiotherapy service.

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