Shilpen Patel MD, FACROAssociate Professor Departments of Radiation Oncology & Global Health University of Washington

Founding Board MemberRadiating Hope

Director of Radiation Oncology RAD-AID International

CANCER IN DEVELOPING COUNTRIES:

Quick facts:7 out of 10 cancer deaths globally occur in

developing countriesCancer kills more people than HIV/AIDS,

Malaria, and Tuberculosis combinedDeveloping countries make up roughly 85%

of the world’s population, and possess only one third of the world’s radiation equipment.

Developing countries lack availability to radiation equipment and the equipment they do have is usually outdated and insufficient

1. Salminen E, Anacak Y, Laskar S, et al: Twinning partnerships through International Atomic Energy Agency (IAEA) to improve radiotherapy in common paediatric cancers in low- and mid-income countries. Radiother Oncol 93:368–371, 2009.2. International Atomic Energy Agency: Design and implementation of a radiotherapy programme: Clinical, medical physics, radiation protection and safety aspects. [IAEA-TECDOC-1040.] Vienna, Austria, International Atomic Energy Agency,1998.

INCIDENCE

The number of new cancer cases per year is estimated to be 15 million in 2015, of which two-thirds occurs in developing countries.

•“It is not an exaggeration to say that cancer represents an imminent crisis for developing countries.”

• IAEA Director General Yukiya Amano

3. Ferlay J, Shin HR, Bray F, et al: Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 127:2893-2917, 2010. 4. Farmer P, Frenk J, Knaul F, et al: Expansion of cancer care and control in countries of low and middle income: a call to action. Lancet 376:1186-1193, 2010.

Tanzania Africa, 2010

BY THE NUMBERS:

• US: Approximately 1 machine

for 105,000 people2% of machines are cobalt

Africa: 1 machine for 4.8 million

people48% of machines are cobalt

South America: 1 machine for 640,000

people39% of machines are cobalt

Nepal: 1 machine for 6 million

people40% of machines are cobalt

Figure from IAEA (www.IAEA.org)- DIRAC

AFRICA:

Rwanda: No machines

Uganda: 1 machine per 33,000,000

Tanzania: 1 machine per 14,000,000

Sudan: 1 machine per 7,000,000

Mali: No machines Senegal:

1 machine per 13,000,000 Ghana:

1 machine per 1,000,000 Ethiopia:

1 machine per 70,000,000 South Africa:

1 machine per 1,000,000

International Atomic Energy Agency: DIRAC (Directory of Radiotherapy Centres). Updated February 2011. Available at: http://www-naweb.iaea.org/nahu/dirac/informationupdate.asp. Accessed July 21, 2011.

Mission: to provide and update radiation equipment in developing countries and advance cancer care in those countries.

PROJECTS:

Radiation Therapy Project Saves cancer patients in developing

countries Thousand upon thousands of lives

are saved with one machine

Prayer Flag Project Involves people locally giving hope

and strength to them Allows survivors to ‘Pass Along a

Cure’

Mountaineering Project Allows people to climb for cancer Allows cancer survivors to become

‘super-advocates’

RADIATION THERAPY PROJECT

We accept used machines and donated radiation therapy equipmentWe provide a tax deduction for these

machinesMost machines are valued at 200,000 up

to 1 million dolalrs

We then refurbish and ship the machines

Partnering with: Physicians Clinics and Hospital Radiation equipment

manufacturers Non-profit organizations

We then train the physicians and provide ongoing support and partnerships

Panama City, Panama

RADIATION THERAPY PROJECT

Partnering countries: Panama-

Brachytherapy equipmentValue $150,000, RadHope 0

Chile- Children’s Cancer Hospital- Toys

Value $500, RadHope 0 Honduras-

Two radiation therapy machinesValue $400,000, RadHope 0

Peru- One radiation Megavoltage machine

Value $1 Million, RadHope 0 Ethiopia-

Hospital equipment and hygiene kits Senegal-

Radiation Machine and suppliesValue$ 750,000, RadHope $80,000

Madagascar- Radiation Machine

Value $1 mil, RadHope 0 Tanzania-

Radiation centerValue$2 million, RadHope 0

Ukraine- Radiation Machine

Value $1.5 million, RadHope 0

SENEGAL PROJECT:

Currently there is one Radiation Oncology Center in Senegal Africa

The Institut Curie de L’Hopital Aristide Le Dantec, located in the city of Dakar.

Senegal is a country of over 13 million people which currently  has only one radiation machine

Radiation Clinic, Senegal Africa

SENEGAL PROJECT:

The Institut Curie: -Cobalt -No HDR -Simulator

Facutly: -2 Rad Oncs -3 physicists -3 therapist -no nurse

Goal: implement HDR brachytherapy

Radiation Clinic, Senegal Africa

SENEGAL PROJECT:

Most common cancer: -40% cervical

Tx for cervical cancer: -External beam, 45 Gy -Boost with external

beam -surgery

Outcomes: mostly palliative

SENEGAL PROJECT: ARRIVAL OF THE HDR MACHINE

SENEGAL PROJECT: OUTREACH

CONCLUSIONS

• Much work needs to be done• Both equipment and training is needed• We need to do more with less money• Critical need is for a true collaboration of:

• The Ministry of Health and the Government• The donor community• The local medical providers• The people themselves• Non government organizations/Non profits