Quantification of trends in radiation oncology infrastructure in Pakistan, 2004-2009

To provide objective estimates of radiation oncology infrastructure in Pakistan for the years 2004 and 2009 in order to quantify trends in radiotherapy facilities, patient load and to identify the future needs.

Nationwide surveys using structured questionnaires were conducted in 2005 and 2010 by the Institute of Radiotherapy and Nuclear Medicine, Peshawar, to assess the status of radiation oncology infrastructure in 2004 and 2009. The data were analyzed to observe the trends.

Megavoltage teletherapy machines increased from 37 in 2004 to 41 in 2009. New patients registered in all radiotherapy centers were 33 369 in 2004 and 46 114 in 2009. Conventional simulators used for tumour localization increased from 15 to 21 and computerized tomography simulators from 0 to 07. Radiation treatment planning systems for dose calculations of tumors and vital organs increased from 15 to 26 and brachytherapy units from 12 to 13. There were 725 patients per medical physicist in 2004 versus 632 in 2009. Patients per radiation oncologist were 439 in 2004 versus 549 in 2009. Number of radiotherapy technologists/shift/machine was 1.69 in 2004 versus 1.90 in 2009. Repair maintenance personnel improved from 2.11/2 megavoltage units in 2004 to 2.49 in 2009.

While there was an increase in number of radiotherapy centers, equipment and human resources available, this was insufficient to comply with international guidelines. An adequate enhancement in radiation oncology infrastructure is needed to cope with the predicted rise in cancer incidence.