Surviving cancer often depends on where you live

What you can do to ensure everyone can access lifesaving treatments?

In the US, a cancer diagnosis means fear, pain, and months of difficult treatments.

In Tanzania, a cancer diagnosis usually means a death sentence.

Ms. Dina Pauline Bina, a mother of three boys, knew that when she heard her diagnosis. “The day we were told I have a malignancy,” she said in an interview, “I thought, ‘This is the end of my life.’ It was a dark day in our lives.” Her vision of the future narrowed; she had once dreamed of seeing her sons graduate from college, get married, and even have children of their own, but now she didn’t expect to see that day.

In fact, her diagnosis was treatable; the problem was infrastructure. According to Boyle, Ngoma, Sullivan, and Brawley (2019), Tanzania’s medical equipment for cancer treatment is woefully insufficient: It only has one radiotherapy machine for as many as 10 million people—in contrast to well-resourced nations like Austria, where one machine serves 200,000 people or fewer. In other developing nations, cancer patients are even worse off, with no radiotherapy facilities in their country at all.

“In places that we don’t have this type of hospital, a lot of people are dying,” Ms. Bina said. “Not because they have to die at that particular time, but because they didn’t have the right medical facility.”

She was lucky: Ultimately, she was chosen for a government program that flies cancer patients outside the country for treatment. On the day Ms. Bina arrived at a modern hospital in Chennai, India, her chart was full of test results by midday. She started chemotherapy within two weeks and traveled to Chennai twice more for follow-up; now, she is cancer-free.

Unfortunately, few cancer patients in Tanzania share her good fortune. Kohi, von Essen, Masika, Gottvall, and Dol (2019) interviewed Tanzanian children and young adults with cancer, and they found that these patients’ experiences were very different. One described long delays before starting treatment; when she finally did, the hospital was unable to make a diagnosis. “At the hospital,” she recounted, “they said, ‘We are not sure about this disease, but we shall give you these drugs.’” Her swelling symptoms continued, and when she returned to the hospital, she was told they couldn’t do the investigation there at all, and she needed to go elsewhere.

Describing painful symptoms, long journeys to clinics, and week-long delays when they arrived at the hospital, the patients pinpointed equipment deficits as part of the problem. “They have to improve,” said a female patient. “They should buy radiotherapy machines. Even though they have two, one of them is not working so there is only one.” She also noted that “it is very difficult for a technician to come,” so when machines break, they stay out of commission for a long time—a problem also described by Boyle et al. (2019).

This patient’s suggestion is a good idea, but we have a long way to go before enacting it. According to one study by the IAEA, radiology equipment is heavily concentrated in North America and Western Europe, even though only 7.2% of the world’s population lives in these regions. 88% of the world’s linear accelerators are located in high-income and upper-middle income regions, leaving very few for the world’s poorest countries. Of the radiotherapy machines that do exist in these countries, most are cobalt-60 machines that lack modern functionalities like an electrons option or multi-leaf collimators, and they are out of order for a significant amount of the time.

Given that these machines often cost multiple millions of dollars when purchased brand-new, the shortages are no surprise. And while foreign donations can help address the problem, this alone is not a solution. Foreign aid can fluctuate depending on the donor countries’ economic health, and much of it is earmarked for specific uses: Facilities cannot simply spend it on radiology equipment at their discretion. What’s really needed is a reliable source of low-cost equipment—and ROS is doing important work in this area. We source linear accelerators from wealthy countries, where clinics often upgrade their equipment even when it has many years left in its useful life. Then we relocate and repurpose these machines, placing them in developing countries at deep discounts from their list prices.

“Every day in my home, we pray,” Ms. Bina said of her treatment. “We thank God that I got a chance to come from my country… [because the government] thought it fit to help people have a second life.”

Her story ends happily—but patients in Tanzania and other low-income countries shouldn’t have to fly across oceans to find their own happy endings. If you work for or manage a cancer center in a wealthy nation, think twice before disposing of your used linear accelerator. Most of these machines are being removed and scrapped, with their metals sent to recycling yards. Instead of allowing this fate for your linac, sell or donate it to an organization that will place it in a part of the world where it’s very much needed.  It’s not just the best choice for the environment—it will also give people like Ms. Bina hope after their cancer diagnosis.