Access to radical and palliative radiotherapy in low- and middle-income countries: challenges, progress, and future...

Low- and middle-income countries (LMICs) bear over half of the global cancer mortality but have access to only 5% of global radiotherapy resources. As the cancer burden rises and equity in palliative care gains global attention, a focused review on palliative radiotherapy access in LMICs is both timely and necessary.

Barriers to radiotherapy access in LMICs are multifaceted, including infrastructure gaps, workforce shortages, geographic centralization, high out-of-pocket costs, and systemic underinvestment. Palliative radiotherapy, despite its proven cost-effectiveness and impact on quality of life, is often excluded from national cancer plans and health strategies. Innovative approaches such as hypofractionation, mobile units, AI-assisted planning, and public-private partnerships are emerging to address these gaps. Efforts by the International Atomic Energy Agency and local governments have led to progress in several regions, with case studies from Africa, Asia, and Latin America showing promising results.

Integrating radiotherapy - particularly palliative radiotherapy - into national cancer and palliative care strategies is essential. Sustainable financing, decentralized service models, and context-specific technologies are critical to overcoming current limitations. Bridging this gap is not only a public health necessity but also a moral imperative to reduce suffering and support patients' dignity and societal contributions.