Infrastructural needs for Nepal’s radiotherapy services

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Year 2016 has been a significant year for cancer treatment in Nepal. Nepal Cancer Hospital and research center (NCHRC) in Lalitpur will soon start radiotherapy services with Varian Truebeam machine while Kathmandu Cancer Care and Research Center (KCCRC) in Bhaktapur has already started the services with Elekta Synergy machine recently. Both of these machines are modern medical linear accelerators from two different companies. Previously, only BP Koirala Cancer Hospital (BPKCH) in Bharatpur and Manipal Hospital in Pokhara had medical LINACS. NCHRC is also going to start High Dose Rate Brachytherapy with 24 Channel Gammamed ix plus machines to treat gynecological malignancies. With the addition of these two new external beam radiotherapy machines in Nepalese Health Care system and one HDR Brachytherapy machines, we are now capable of performing modern cancer treatment techniques like 3DCRT, IMRT, VMAT/Rapid Arc, Stereotatic Radiosurgery & Stereotatic Body Radiotherapy, Total Body Irradiation in the country.

Previously, cancer patients who had indication for such treatment techniques had to go abroad to receive treatments. That would put tremendous financial, psychological and practical difficulties for cancer patients and their families. Hence, the new medical facilities in the country are sure to relieve such pressures from patients and their families.

However, with the addition of new facilities in diagnostic radiology and radiation therapy, there is a rising challenges on the part of the service providers and government of Nepal to establish adequate radiation infrastructure for smooth functioning of such facilities in the country.

Firstly, since radiation therapy machine produces ionizing radiation to cure malignancies, proper handling of such equipment is important. There should be a quality assurance mechanism to ensure quality treatment with these machines. Proper treatment outcome of radiotherapy requires the joint effort of Radiation Oncologists, Medical Physicists, Radiation Technologist, Oncology Nurses and others involved. Nevertheless, Medical Physics, Radiation Technology and Oncology Nursing courses are not offered in the country. So there is a shortage of these professionals in the country. GoN should take actions to prepare such human resources in the country.

Secondly, radiation monitoring is an important aspect of radiation safety. But a lack of radiation law, radiation regulatory body and infrastructural arrangement pose challenges in adopting proper guidelines and dose audits. Therefore, it is important to draft radiation law, establish regulatory body and make infrastructural arrangement as soon as possible.

Thirdly, most radiotherapy machines and related equipments are specially designed highly advanced machine. Establishing radiotherapy facilities requires huge investment. The government of Nepal should facilitate in all possible ways to encourage health service entrepreneurs and hence increase access to specialized health services for cancer patients within the country. This will ultimately appease cancer patients and their near ones by minimizing their financial burden, psychological pressure. In addition, fund worth millions of rupees is retained in the country which would otherwise be spent aboard to get the radiotherapy services there.

The rise in the number of radiation facilities, particularly megavoltage radiotherapy facility, can provide most effective and smooth service to patients only if basic and additional infrastructures for quality radiotherapy services are put into place.

(Poudel is Medical Physicist at Nepal Cancer Hospital and Research Center, Harisiddhi, Lalitpur)

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