Radiotherapy (also called radiation therapy) has been used for over a century, as an increasingly effective treatment for cancer. It uses high-energy rays or radioactive substances to damage and eliminate cancerous tumours at a cellular level. Radiotherapy is globally acclaimed as it is highly effective while causing fewer side effects compared to chemotherapy, a drug-based treatment modality for cancer.
More than 50 percent of cancer patients would benefit from radiation therapy, but only 30 percent receive it. In developing countries, actual utilization is approximately 28 percent, whereas in Europe overall, it is around 32-35 percent. Paradoxically, the actual figures in low- and middle-income countries fall short of the recommended utilization rate primarily due to a lack of access to radiotherapy devices. Therefore, the large-scale availability of advanced radiotherapy equipment and services that add value in the current context is an essential requisite for effective cancer management in developing countries such as India.
Amongst the few who have been working tirelessly to solve this problem, Elekta, led by Manikandan Bala in India, is focused on changing the current landscape of care through its innovative solutions, some even tailored to the current Indian context.
Shortcomings in the current cancer management framework
Cancer treatment is already unaffordable for a sizeable portion of oncology patients in India and factors such as insufficient and underdeveloped cancer care infrastructure, high custom duty on life-saving equipment, and a lack of well-structured academic training for radiotherapy technology add to the burden. Additionally, the existing cancer treatment facilities lack the robust radiation therapy configurations and financial support needed to manage the present load of patients. And there is a nationwide shortage of trained professionals such as medical physicists, radiotherapy technologists, and radiation oncologists that is gradually disabling the Indian cancer management framework.
To rectify these gaps in the system, programs and policies based on sound public health principles must be introduced. Judicious use of existing resources while simultaneously increasing the number of regional cancer centres can assist countries like India in gradually mitigating the huge gap between supply and demand that persists in the oncology market at present.
Innovation can also address certain challenges met in counties like India. Manikandan Bala, Elekta’s Senior Vice President for TIMEA & Asia Pacific, explains, “Our support services offer real-time data monitoring, remote access and screen sharing enabled by our Elekta IntelliMax® technology. This means we can predict issues before they even occur and resolve them remotely, making sure that access to quality radiotherapy for patients is not hampered.”
He adds, “Access in the form of treatment availability is absolutely critical for this fight against cancer. We are also working closely with the government on public-private partnership (PPP) projects for government facilities enabling clinical excellence and technology closer to their homes, at an affordable cost. . . On the upskilling side, Elekta partners with private and governmental healthcare providers to develop centres of excellence focused on training, skill development and education.
In a nutshell, there are innovative multipronged approaches being to put into action so that we can help provide a fighting chance to each individual dealing with cancer.
Leveraging technology to improve radiotherapy treatment
Other technological advancements can be leveraged to improve the quality of care and outcomes for patients undergoing radiation therapy. By automating manual processes, the speed and quality of treatment can be significantly improved. AI-based algorithms can augment the accuracy and precision of image-guided radiotherapy, and sophisticated data collection tools can facilitate cancer research and oncology informatics.
Oncology EMRs allow the clinical staff in the hospitals to view the history, clinical assessments, and investigational reports of the patient in real-time. This helps reduce the waiting period of the patients for the retrieval of old files, thereby improving the quality of patient care.
Additionally, Oncology EMRs make medical notes more clear and easily available, improving the safety of patient care. Having immediate access to patient information reduces the time taken for RT planning, which in turn helps to start the treatment early. The EMR also accurately identifies all the personnel who enter data into the patients’ records along with the exact time of data entry. Unprecedented technological advancements are making cancer treatment more personalized and convenient for patients. A shining example of an EMR that does this flawlessly is Elekta’s MOSAIQ.*
One such example of technology tailored to Indian/ emerging market requirements is the Elekta Harmony linear accelerator, developed on the feedback of clinicians across south Asia. How does Elekta Harmony do it? Having a 30 percent smaller footprint than Elekta’s other linacs, Harmony is a cost-efficient workhorse for any clinic, with the versatility needed to treat the most common cancer indications. This makes radiotherapy accessible to virtually any centre that needs it.
Elekta also brings the latest technology like Unity – state of art MR-Linac to India as a part of a global launch.
Making radiotherapy more patient-friendly
Radiotherapy is a recommended treatment for more than half of all cancer patients. However, due to the lack of radiotherapy centres in India and their extremely skewed distribution across the nation, most patients are deprived of the therapy.
In order to make radiotherapy more accessible, it is essential to establish more oncology centres across the nation to increase access and improve the patients’ outcomes. Government support to private hospitals, in the form of incentives like subsidies on supplies and financial support, for setting up centres in the rural regions can help tremendously in overcoming the imbalanced distribution of available treatment centres.
Additionally, lowering the cost of radiation therapy can shrink the financial burden of treatment for patients in middle-income and low-income households. This can be achieved through public-private partnerships wherein the government incentivizes private hospitals to provide cancer treatment in poorer sections of the society at an affordable/subsidized rate.
But the challenge of making treatment accessible can also be addressed by improving the quality of the care available, not just the number of treatment devices available. The clinical adoption of new technology, for example, hypofractionation and adaptive treatments, can help established clinics treat more patients in the same amount of time as today. This way, one can expect more people to have access to the best cancer care.
Elekta: The leading innovator in the field of precision radiotherapy
Elekta is the leading innovator of precision radiation therapy solutions and has pioneered a large number of advances in cancer care and the treatment of brain disorders. The company provides state-of-the-art medical equipment, which offers a wide range of treatments including radiotherapy, stereotactic therapy, brachytherapy, and neurosurgery to patients across the globe.
Although the company celebrates its 50th anniversary this year, it is its history that drives it forward. Elekta is working towards a future where everyone can benefit from precise and individually tailored radiotherapy treatments, regardless of their need or location.
The road ahead
Radiotherapy is recognized as an essential component in the management of cancer. The therapy is often administered in conjunction with chemotherapy and/or surgery or used independently. However, due to certain limitations in our cancer care framework, there are many challenges related to accessibility and feasibility for Indian cancer patients. These limitations can be overhauled with a few steps in the right direction:
● By reducing/waving the custom duty imposed on crucial radiotherapy equipment, the government can induce a steep reduction in the overall cost of building radiotherapy and cancer treatment centres.
● Incentivizing private hospitals to build treatment centres in remote and rural areas can even the distribution of radiotherapy facilities across India.
● Establishing a well-structured curriculum that educates students and medical practitioners about medical physics, oncology, and radiotherapy technology is imperative to reducing the gap between the supply and demand of oncologists.
Armed with policies aimed at improving the quality of life of people with cancer and enhancing the medical facilities available for them, developing countries like India can wage a war against the disease and prevent it from getting a stronghold amongst the population.
*More details around Elekta MOSAIQ can be found on the paper:
Sunil RA, Vishwanath L, Kumar S, Navven T, Pallad S, Latha A, et al. Implementation of the electronic medical record system in the radiation oncology department of a government healthcare facility: A singlecenter experience. Cancer Res Stat Treat 2020;3:748-54.