Radiotherapy services in Brazil: current scenario, challenges, and proposals for solutions

This study aimed to provide a consensus-based short list of barriers and challenges to establish accessible radiotherapy services in Brazil and to discuss the managerial actions proposed to reduce the waiting time to initiate radiotherapy treatments. An e-Delphi study was made with no direct interaction between respondents. Virtual surveys were sent to physicians who had expertise in radiotherapy. A baseline list of 15 previously published barriers to radiotherapy access in low- and middle-income countries was put in topics. Participants had to rate the priority of including each of the 15 topics in future governmental interventions by using a 5-point Likert scale. Average scores for each topic were calculated and expressed as percentages. Consensus was achieved if the topic obtained a score of > 70% agreement among the participants that rated it as very high or high priority, plus being in the top five in the ranking list of importance. Four topics reached consensus. Two topics were related to costs (resources, funding models, and financial stability), one to policy environment (political instability), and one to poverty levels and planning distribution of technology. Such results form the basis for an action plan and the comprehensive priority topics should be considered in the efforts to provide better access to radiotherapy services.