Presentation at PORTAGE (Paediatric Oncology Roundtable to Transform Access to Global Essentials) Inaugeral Meeting, hosted by Friends of Cancer Patients, Childhood Cancer International and International Society of Paediatric Oncology, 16-18 January 2018, Sharjah, UAE

1. Anja Nitzsche
Head of Resource Mobilization, IAEA Programme of Action for Cancer
Therapy (PACT)
PORTAGE Inaugural Meeting, Sharjah, UAE
16 January 2018
Access to Global Radiotherapy Essentials
Paediatric Radiation Oncology:
Closing the Gap

2. The silent crisis
•Globally, childhood mortality has been decreasing
 Cancer incidence on the rise, including for
childhood cancers
• Low & middle income countries (LMIC)
disproportionally affected
 Proportion of paediatric cancers much higher
(3-6%) compared to HICs (<2%)
 Mortality in LMICs: 70-80% vs 20-30% in HICs

3. Inequity in access to cancer care
Sources: CONCORD-2, Lancet 2015; SurvCan IARC 2011

4. A growing concern
Figure 1: Geographic distribution of the world's population younger than 15 years in 2015
(http://data.worldbank.org/indicator/SP.POP.0014.TO.ZS?end = 2015&locations = XO&start = 1960&view = map)

5. Dedicated pediatric radiotherapy
• Essential component of high-quality childhood
cancer services; combined with surgery and
chemotherapy
• Can limit late effects in paediatric cancer patients
who largely present with curable tumours
• Required for ~ 50% of paediatric cancer patients
• By 2035, more than 7 million of projected cancer
cases requiring RT will occur in LMICs: a large
proportion of whom will be children = growing
demand

6. Role of radiotherapy in paediatric cancers
6
Tumour
Annual incidencea
(per million
population)
Peak age and range a
Radiotherapy integral
component
Additional essential
modalities
CNS tumours 16.5–32.5 0–7 (0–15) Yes Surgery
Retinoblastoma 2.1–5.6 0–2 (0–4) Yes/alternative modality Surgery + chemotherapy
Leukemias 29.4–50.4 3–4 (1–8)
Special indications (total
body, brain/testes relapse
prevention)
Chemotherapy
Lymphomas 13.5–37.7 14–15 (9–15) Yes Chemotherapy
Wilms’ tumour 5.1–9.2 3–4 (0–7) Yes Surgery + chemotherapy
Neuroblastoma 6.1–15.8 0–2 (0–4) Yes Surgery + chemotherapy
Soft-tissue sarcomas 6.3–11.0 1–5 (0–15) Yes Surgery + chemotherapy
a Age and incidence reflects the data from US, Europe and the Middle East.
Source: Salminen, E, et al. Elsevier (2009)

7. Inequity in access to RT
(Example of radiotherapy)
An estimated shortfall of over 5,000 radiotherapy machines in LMICs
Source: GLOBOCAN 2012, IAEA 2016

8. Access to RT Technology by Type
Worldwide access to cobalt and linac radiotherapy machines (Directory of
radiotherapy centres [DIRAC], IAEA accessed June 8, 2017)

9. •Insufficient capacity/infrastructure to provide RT for
paediatric cancer patients
•Lack of support for related disciplines, e.g.
anaesthesiology
•Lack of government commitment & funding
•Insufficient opportunities for professional training and
education
•Poorly developed protocols and sub-optimal quality
assurance
•Limited awareness of paediatric malignancies
•Limited knowledge of long-term effects – treatment
failure often due to abandonment and toxicity
Main challenges of PRO in LMICs
Source Salminen, E, et al. Elsevier (2009)

10. What needs to be done?
• Training for radiation oncology and other specialties
• Upgrading or building oncology/RT services
• Developing registries for accurate documentation of paediatric
malignancies/cancers
• Identifying and developing centres for specialised training
programmes (regional level)
• Increasing awareness
• Developing locally adapted protocols to ensure effectiveness and
correct dosage of radiotherapy
• Invest ng in QA, QM
“The greatest obstacle low-income countries face in the
development of organized approaches to childhood cancer
is the scarcity of skilled health professionals”.
Source: Salminen, E, et al. Elsevier (2009)

11. Technology & knowledge transfer to enable the effective,
high-quality, safe, secure and sustainable application of
nuclear techniques for better health through:
• Training of health professionals
(short-term and long-term fellowships, ongoing medical
education and medical training, e-learning platforms, webinars,
curricula)
• Infrastructure development, project support & funding
• Normative guidance and standards (jointly with WHO)
• Quality assurance/control
• Coordination of international research projects, data compilation
• Collaboration with other organizations
The IAEA’s role in global health

12. AFRICA
€86 million
EUROPE
€73 million
LATIN AMERICA
€72 million
ASIA and the
PACIFIC
€65 million
INTERREGIONAL
€9 million
TOTAL EXPENDITURE
€305 million
IAEA Expenditure on Cancer-related
Projects (1980-2016)

13. OUR GOAL:
To improve
cancer
survival in
developing
countries
PACT, a Joint Programme with
the World Health
Organization (WHO):
Advocates an holistic, country
level, bottom-up approach
Integrates radiation medicine
into national cancer
control programmes
Advocates to place cancer on
development agenda
Mobilizes resources for planning
and implementation of NCCPs

14. Current IAEA Technical Cooperation Projects
Location Project
Venezuela Building Ocular Brachytherapy Capacities at the Ocular Oncology Unit of
the Dr. Luis Razetti Oncology Institute
Guatemala Improving Radiology Services at the General Hospital San Juan de Dios
Montenegro Improving Paediatric Diagnostic in Computed Tomography Examinations
Proton Therapy Projects:
Colombia Establishing a New Oncology Unit at the Carlos Ardila Lülle Hospital for the
Improvement of Quality of Life in Children and Adult Patients with Cancer
Thailand Developing Human Resources for the National Proton Therapy Centre in
Thailand
Singapore Building up Expertise and Capability in the Application of Proton Therapy
Regional Projects:
Asia/Pacific Strengthening Capacity to Manage Non-Communicable Diseases Using
Imaging Modalities in Radiology and Nuclear Medicine
Latin America Taking Strategic Actions to Strengthen Capacities in the Diagnostics and
Treatment of Cancer, including paediatrics

15. Partnership opportunities
15
Help ensure that childhood cancer becomes and stays a
global child health priority
• With all children and adolescents receiving the cancer treatment
and care they need
Partnership with CCI and others:
– Resource mobilization and outreach initiatives
– Joint communication and awareness-raising
– Training and capacity-building activities
– Inform policy-makers
– International coordinated research activities

16. Closing the gap
Source: IARC, GLOBOCAN 2012

17. Thank you
cancer.iaea.org #CancerCare4All