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- Title
Geographic Accessibility and Availability of Radiotherapy in Ghana.
- Authors
Scott, Aba Anoa; Polo, Alfredo; Zubizarreta, Eduardo; Akoto-Aidoo, Charles; Edusa, Clement; Osei-Bonsu, Ernest; Yarney, Joel; Dwobeng, Bismark; Milosevic, Michael; Rodin, Danielle
- Abstract
Key Points: Question: What is the treatment capacity and geographic accessibility of radiotherapy in Ghana? Findings: In this cross-sectional study of patients in Ghana eligible for external beam radiotherapy in 2020, only 23% of patients received treatment, with the highest rates of radiotherapy utilization in regions with the shortest distance to a radiotherapy facility. The median Euclidean distance from the district centroids to the nearest radiotherapy facility was 110.6 km, and only 47% of the population lived within a 100-km radial distance. Meaning: These findings suggest that there is an enormous need to scale up the availability of radiotherapy in Ghana, with consideration for the population distribution and disparities in treatment accessibility across the country. This cross-sectional study estimates the gaps in radiotherapy machine availability in Ghana and describes the association between distance and access to care. Importance: Radiotherapy is critical for comprehensive cancer care, but there are large gaps in access. Within Ghana, data on radiotherapy availability and on the relationship between distance and access are unknown. Objectives: To estimate the gaps in radiotherapy machine availability in Ghana and to describe the association between distance and access to care. Design, Setting, and Participants: This is a cross-sectional, population-based study of radiotherapy delivery in Ghana in 2020 and model-based analysis of radiotherapy demand and the radiotherapy utilization rate (RUR) using the Global Task Force on Radiotherapy for Cancer Control investment framework. Exposures: Receipt of radiotherapy and the number of radiotherapy courses delivered. Main Outcomes and Measures: Geocoded location of patients receiving external beam radiotherapy (EBRT); median Euclidean distance from the district centroids to the nearest radiotherapy centers; proportion of population living within geographic buffer zones of 100, 150, and 200 km; additional capacity required for optimal utilization; and geographic accessibility after strategic location of a radiotherapy facility in an underserviced region. Results: A total of 2883 patients underwent EBRT courses in 2020, with an actual RUR of 11%. Based on an optimal RUR of 48%, 11 524 patients had an indication for radiotherapy, indicating that only 23% of patients received treatment. An investment of 23 additional EBRT machines would be required to meet demand. The median Euclidean distance from the district centroids to the nearest radiotherapy facility was 110.6 km (range, 0.62-513.2 km). The proportion of the total population living within a radius of 100, 150 and 200 km of a radiotherapy facility was 47%, 61% and 70%, respectively. A new radiotherapy facility in the northern regional capital would reduce the median of Euclidean distance by 10% to 99.4 km (range, 0.62-267.7 km) and increase proportion of the total population living within a radius of 100, 150 and 200 km to 53%, 69% and 84%, respectively. The greatest benefit was seen in regions in the northern half of Ghana. Conclusions and Relevance: In this cross-sectional study of geographic accessibility and availability of radiotherapy, Ghana had major national deficits of radiotherapy capacity, with significant geographic disparities among regions. Well-planned infrastructure scale-up that accounts for the population distribution could improve radiotherapy accessibility.
- Subjects
GHANA; RADIATION therapy equipment; HEALTH services accessibility; CROSS-sectional method; POPULATION geography; MEDICAL care; RETROSPECTIVE studies; ACQUISITION of data; MEDICAL care use; MAPS; RADIATION doses; DESCRIPTIVE statistics; MEDICAL records; RESEARCH funding; DATA analysis software; CANCER patient medical care
- Publication
JAMA Network Open, 2022, Vol 5, Issue 8, pe2226319
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2022.26319