• Manjit Dosanjh, Vesna Gershan, Eugenia C Wendling, Jamal S Khader, Taofeeq A Ige, Mimoza Ristova, Richard Hugtenburg, Petya Georgieva, C Norman Coleman, David A Pistenmaa, Gohar H Hovhannisyan, Tatul Saghatelyan, Kamal Kazimov, Rovshan Rzayev, Gulam R Babayev, Mirzali M Aliyev, Eduard Gershkevitsh, Irina Khomeriki, Lily Petriashvili, Maia Topeshashvili, Raushan Zakirova, Aigerim Rakhimova, Natalya Karnakova, Aralbaev Rakhatbek, Narynbek Kazybaev, Oksana Bondareva, Kristaps Palskis, Gaļina Boka, Erika Korobeinikova, Linas Kudrevicius, Ion Apostol, Ludmila V Eftodiev, Alfreda Rosca, Galina Rusnac, Mukhabatsho Khikmatov, Sergii Luchkovskyi, Yuliia Severyn, Jamshid M Alimov, Munojat Ismailova, and Suvsana M Talibova.
• Department of Physics, University of Oxford, UK; International Cancer Expert Corps (ICEC), Washington, DC, USA. Electronic address: manjit.dosanjh@physics.ox.ac.uk.
• Lancet Oncol. 2024 Nov 1; 25 (11): 148714951487-1495.

BackgroundOnly 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.MethodsThis 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.FindingsData 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).InterpretationOur 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.FundingUS Department of Energy's National Nuclear Security Administration's Office of Radiological Security.Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

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