Radiotherapy gaps and new frontiers in the Commonwealth

Compounding the issue of machine availability is the overuse of extended treatment schedules, which increase the operational costs of radiation delivery and decrease patient affordability.1 Abdel-Wahab and colleagues estimate that using higher doses per day over a shorter period of time (hypofractionation) for patients with breast or prostate cancer would allow an additional 2·2 million patients to be treated in 2024 with existing resources and would result in potential cost savings of up to US$5·51 billion. Despite robust long-term evidence, previous surveys have found that a preference for moderate hypofractionation over conventional hypofractionation in countries in Africa is only 40% for node-negative breast cancer and 19% and 33% for low-risk and intermediate-risk prostate cancer, respectively.9 Solutions to alter this preference include modifying reimbursement plans to de-incentivise physicians from prescribing longer courses of radiotherapy, and knowledge translation around clinical guidelines. A view of the earth from space with night lights Matthias Kulka/Getty Images DR is a member of the Board of Directors and receives travel support from the Union for International Cancer Control; declares grant funding from the Canadian Cancer Society and the Leukemia and Lymphoma Society; and declares consulting fees and stock options from Need.