Expanding radiotherapy access in Sub-Saharan Africa: an analysis of travel burdens and patient-related benefits of hypofractionation

Saloni Patel; Elizabeth Olatunji; Abba Mallum; Binsila Bernard Benjika; Adedayo O Joseph; Shomari Joseph; Nwamaka Lasebikan; Habiba Mahuna; Mamsau Ngoma; Twalib Athumani Ngoma; Godwin Nnko; Chinelo Onwualu; Mariza Vorster; Wilfred Ngwa

doi:10.3389/fonc.2023.1136357

Expanding radiotherapy access in Sub-Saharan Africa: an analysis of travel burdens and patient-related benefits of hypofractionation

Front Oncol. 2023 Apr 18:13:1136357. doi: 10.3389/fonc.2023.1136357. eCollection 2023.

Authors

Saloni Patel¹, Elizabeth Olatunji¹, Abba Mallum^{2

3}, Binsila Bernard Benjika⁴, Adedayo O Joseph⁵, Shomari Joseph⁶, Nwamaka Lasebikan⁷, Habiba Mahuna⁶, Mamsau Ngoma⁶, Twalib Athumani Ngoma^{6

8}, Godwin Nnko⁶, Chinelo Onwualu⁷, Mariza Vorster⁹, Wilfred Ngwa^{1

10}

Affiliations

¹ Johns Hopkins University School of Medicine, Baltimore, MD, United States.
² Department of Radiotherapy and Oncology, University of KwaZulu-Natal, Durban, South Africa.
³ Department of Oncology, Inkosi Albert Luthuli Central Hospital, Durban, South Africa.
⁴ Department of Public Health, ICT University USA, Yaoundé, Cameroon.
⁵ NSIA-LUTH Cancer Center, Lagos University Teaching Hospital, Lagos, Nigeria.
⁶ Ocean Road Cancer Institute, Dar Es Salaam, Tanzania.
⁷ Oncology Center, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, Nigeria.
⁸ Department of Clinical Oncology, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania.
⁹ College of Health Science, University of KwaZulu-Natal, Durban, South Africa.
¹⁰ Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States.

Abstract

Purpose: The purpose of this project was to examine the travel burdens for radiotherapy patients in Nigeria, Tanzania, and South Africa, and to assess the patient-related benefits of hypofractionated radiotherapy (HFRT) for breast and prostate cancer patients in these countries. The outcomes can inform the implementation of the recent Lancet Oncology Commission recommendations on increasing the adoption of HFRT in Sub-Saharan Africa (SSA) to enhance radiotherapy access in the region.

Methods: Data were extracted from electronic patient records at the NSIA-LUTH Cancer Center (NLCC) in Lagos, Nigeria and the Inkosi Albert Luthuli Central Hospital (IALCH) in Durban, South Africa, from written records at the University of Nigeria Teaching Hospital (UNTH) Oncology Center in Enugu, Nigeria, and from phone interviews at Ocean Road Cancer Institute (ORCI) in Dar Es Salaam, Tanzania. Google Maps was used to calculate the shortest driving distance between a patient's home address and their respective radiotherapy center. QGIS was used to map the straight-line distances to each center. Descriptive statistics were used to compare transportation costs, time expenditures, and lost wages when using HFRT versus conventionally fractionated radiotherapy (CFRT) for breast and prostate cancer.

Results: Patients in Nigeria (n=390) traveled a median distance of 23.1 km to NLCC and 86.7 km to UNTH, patients in Tanzania (n=23) traveled a median distance of 537.0 km to ORCI, and patients in South Africa (n=412) traveled a median distance of 18.0 km to IALCH. Estimated transportation cost savings for breast cancer patients in Lagos and Enugu were 12,895 Naira and 7,369 Naira, respectively and for prostate cancer patients were 25,329 and 14,276 Naira, respectively. Prostate cancer patients in Tanzania saved a median of 137,765 Shillings in transportation costs and 80.0 hours (includes travel, treatment, and wait times). Mean transportation cost savings for patients in South Africa were 4,777 Rand for breast cancer and 9,486 Rand for prostate cancer.

Conclusion: Cancer patients in SSA travel considerable distances to access radiotherapy services. HFRT decreases patient-related costs and time expenditures, which may increase radiotherapy access and alleviate the growing burden of cancer in the region.

Keywords: breast cancer; cost savings; hypofractionated radiotherapy; prostate cancer; sub-Saharan Africa; time savings; travel distance.

Grants and funding

Research reported in this publication was partially supported by the National Institutes of Health under Award Number R01CA239042. The content is solely the responsibility of the authors and does not necessarily represent the views of the National Institutes of Health.