Establishing and Delivering Quality Radiation Therapy in Resource-Constrained Settings: The Story of Botswana
Identifieur interne : 000419 ( Ncbi/Merge ); précédent : 000418; suivant : 000420Establishing and Delivering Quality Radiation Therapy in Resource-Constrained Settings: The Story of Botswana
Auteurs : Jason A. Efstathiou [Zimbabwe] ; Magda Heunis [Zimbabwe] ; Talkmore Karumekayi [Zimbabwe] ; Remigio Makufa [Zimbabwe] ; Memory Bvochora-Nsingo [Zimbabwe] ; David P. Gierga [Zimbabwe] ; Gita Suneja [Zimbabwe] ; Surbhi Grover [Zimbabwe] ; Joseph Kasese [Zimbabwe] ; Mompati Mmalane [Zimbabwe] ; Howard Moffat [Zimbabwe] ; Alexander Von Paleske [Zimbabwe] ; Joseph Makhema [Zimbabwe] ; Scott Dryden-Peterson [Zimbabwe]Source :
- Journal of Clinical Oncology [ 0732-183X ] ; 2015.
Abstract
There is a global cancer crisis, and it is disproportionately affecting resource-constrained settings, especially in low- and middle-income countries (LMICs). Radiotherapy is a critical and cost-effective component of a comprehensive cancer control plan that offers the potential for cure, control, and palliation of disease in greater than 50% of patients with cancer. Globally, LMICs do not have adequate access to quality radiation therapy and this gap is particularly pronounced in sub-Saharan Africa. Although there are numerous challenges in implementing a radiation therapy program in a low-resource setting, providing more equitable global access to radiotherapy is a responsibility and investment worth prioritizing. We outline a systems approach and a series of key questions to direct strategy toward establishing quality radiation services in LMICs, and highlight the story of private-public investment in Botswana from the late 1990s to the present. After assessing the need and defining the value of radiation, we explore core investments required, barriers that need to be overcome, and assets that can be leveraged to establish a radiation program. Considerations addressed include infrastructure; machine choice; quality assurance and patient safety; acquisition, development, and retention of human capital; governmental engagement; public–private partnerships; international collaborations; and the need to critically evaluate the program to foster further growth and sustainability.
Url:
DOI: 10.1200/JCO.2015.62.8412
PubMed: 26578607
PubMed Central: 5070566
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Establishing and Delivering Quality Radiation Therapy in Resource-Constrained Settings: The Story of Botswana</title>
<author><name sortKey="Efstathiou, Jason A" sort="Efstathiou, Jason A" uniqKey="Efstathiou J" first="Jason A." last="Efstathiou">Jason A. Efstathiou</name>
<affiliation wicri:level="1"><nlm:aff id="aff1">Jason A. Efstathiou, David P. Gierga, Massachusetts General Hospital, Harvard Medical School; Scott Dryden-Peterson, Brigham and Women's Hospital, Boston, MA; Magda Heunis, University of Stellenbosch and Tygerberg Hospital, Cape Town, South Africa; Talkmore Karumekayi, Remigio Makufa, and Memory Bvochora-Nsingo, Gaborone Private Hospital; Joseph Kasese, Bokamoso Private Hospital; Mompati Mmalane, Joseph Makhema, and Scott Dryden-Peterson, Botswana Harvard AIDS Institute; Howard Moffat, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Huntsman Cancer Hospital, Salt Lake City, UT; Surbhi Grover, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and Alexander von Paleske, Mpilo-Hospital, University of Zimbabwe, Bulawayo, Zimbabwe.</nlm:aff>
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<wicri:regionArea>Jason A. Efstathiou, David P. Gierga, Massachusetts General Hospital, Harvard Medical School; Scott Dryden-Peterson, Brigham and Women's Hospital, Boston, MA; Magda Heunis, University of Stellenbosch and Tygerberg Hospital, Cape Town, South Africa; Talkmore Karumekayi, Remigio Makufa, and Memory Bvochora-Nsingo, Gaborone Private Hospital; Joseph Kasese, Bokamoso Private Hospital; Mompati Mmalane, Joseph Makhema, and Scott Dryden-Peterson, Botswana Harvard AIDS Institute; Howard Moffat, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Huntsman Cancer Hospital, Salt Lake City, UT; Surbhi Grover, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and Alexander von Paleske, Mpilo-Hospital, University of Zimbabwe, Bulawayo</wicri:regionArea>
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<author><name sortKey="Heunis, Magda" sort="Heunis, Magda" uniqKey="Heunis M" first="Magda" last="Heunis">Magda Heunis</name>
<affiliation wicri:level="1"><nlm:aff id="aff1">Jason A. Efstathiou, David P. Gierga, Massachusetts General Hospital, Harvard Medical School; Scott Dryden-Peterson, Brigham and Women's Hospital, Boston, MA; Magda Heunis, University of Stellenbosch and Tygerberg Hospital, Cape Town, South Africa; Talkmore Karumekayi, Remigio Makufa, and Memory Bvochora-Nsingo, Gaborone Private Hospital; Joseph Kasese, Bokamoso Private Hospital; Mompati Mmalane, Joseph Makhema, and Scott Dryden-Peterson, Botswana Harvard AIDS Institute; Howard Moffat, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Huntsman Cancer Hospital, Salt Lake City, UT; Surbhi Grover, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and Alexander von Paleske, Mpilo-Hospital, University of Zimbabwe, Bulawayo, Zimbabwe.</nlm:aff>
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<author><name sortKey="Karumekayi, Talkmore" sort="Karumekayi, Talkmore" uniqKey="Karumekayi T" first="Talkmore" last="Karumekayi">Talkmore Karumekayi</name>
<affiliation wicri:level="1"><nlm:aff id="aff1">Jason A. Efstathiou, David P. Gierga, Massachusetts General Hospital, Harvard Medical School; Scott Dryden-Peterson, Brigham and Women's Hospital, Boston, MA; Magda Heunis, University of Stellenbosch and Tygerberg Hospital, Cape Town, South Africa; Talkmore Karumekayi, Remigio Makufa, and Memory Bvochora-Nsingo, Gaborone Private Hospital; Joseph Kasese, Bokamoso Private Hospital; Mompati Mmalane, Joseph Makhema, and Scott Dryden-Peterson, Botswana Harvard AIDS Institute; Howard Moffat, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Huntsman Cancer Hospital, Salt Lake City, UT; Surbhi Grover, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and Alexander von Paleske, Mpilo-Hospital, University of Zimbabwe, Bulawayo, Zimbabwe.</nlm:aff>
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<wicri:regionArea>Jason A. Efstathiou, David P. Gierga, Massachusetts General Hospital, Harvard Medical School; Scott Dryden-Peterson, Brigham and Women's Hospital, Boston, MA; Magda Heunis, University of Stellenbosch and Tygerberg Hospital, Cape Town, South Africa; Talkmore Karumekayi, Remigio Makufa, and Memory Bvochora-Nsingo, Gaborone Private Hospital; Joseph Kasese, Bokamoso Private Hospital; Mompati Mmalane, Joseph Makhema, and Scott Dryden-Peterson, Botswana Harvard AIDS Institute; Howard Moffat, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Huntsman Cancer Hospital, Salt Lake City, UT; Surbhi Grover, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and Alexander von Paleske, Mpilo-Hospital, University of Zimbabwe, Bulawayo</wicri:regionArea>
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<author><name sortKey="Makufa, Remigio" sort="Makufa, Remigio" uniqKey="Makufa R" first="Remigio" last="Makufa">Remigio Makufa</name>
<affiliation wicri:level="1"><nlm:aff id="aff1">Jason A. Efstathiou, David P. Gierga, Massachusetts General Hospital, Harvard Medical School; Scott Dryden-Peterson, Brigham and Women's Hospital, Boston, MA; Magda Heunis, University of Stellenbosch and Tygerberg Hospital, Cape Town, South Africa; Talkmore Karumekayi, Remigio Makufa, and Memory Bvochora-Nsingo, Gaborone Private Hospital; Joseph Kasese, Bokamoso Private Hospital; Mompati Mmalane, Joseph Makhema, and Scott Dryden-Peterson, Botswana Harvard AIDS Institute; Howard Moffat, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Huntsman Cancer Hospital, Salt Lake City, UT; Surbhi Grover, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and Alexander von Paleske, Mpilo-Hospital, University of Zimbabwe, Bulawayo, Zimbabwe.</nlm:aff>
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<wicri:regionArea>Jason A. Efstathiou, David P. Gierga, Massachusetts General Hospital, Harvard Medical School; Scott Dryden-Peterson, Brigham and Women's Hospital, Boston, MA; Magda Heunis, University of Stellenbosch and Tygerberg Hospital, Cape Town, South Africa; Talkmore Karumekayi, Remigio Makufa, and Memory Bvochora-Nsingo, Gaborone Private Hospital; Joseph Kasese, Bokamoso Private Hospital; Mompati Mmalane, Joseph Makhema, and Scott Dryden-Peterson, Botswana Harvard AIDS Institute; Howard Moffat, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Huntsman Cancer Hospital, Salt Lake City, UT; Surbhi Grover, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and Alexander von Paleske, Mpilo-Hospital, University of Zimbabwe, Bulawayo</wicri:regionArea>
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<author><name sortKey="Bvochora Nsingo, Memory" sort="Bvochora Nsingo, Memory" uniqKey="Bvochora Nsingo M" first="Memory" last="Bvochora-Nsingo">Memory Bvochora-Nsingo</name>
<affiliation wicri:level="1"><nlm:aff id="aff1">Jason A. Efstathiou, David P. Gierga, Massachusetts General Hospital, Harvard Medical School; Scott Dryden-Peterson, Brigham and Women's Hospital, Boston, MA; Magda Heunis, University of Stellenbosch and Tygerberg Hospital, Cape Town, South Africa; Talkmore Karumekayi, Remigio Makufa, and Memory Bvochora-Nsingo, Gaborone Private Hospital; Joseph Kasese, Bokamoso Private Hospital; Mompati Mmalane, Joseph Makhema, and Scott Dryden-Peterson, Botswana Harvard AIDS Institute; Howard Moffat, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Huntsman Cancer Hospital, Salt Lake City, UT; Surbhi Grover, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and Alexander von Paleske, Mpilo-Hospital, University of Zimbabwe, Bulawayo, Zimbabwe.</nlm:aff>
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<author><name sortKey="Gierga, David P" sort="Gierga, David P" uniqKey="Gierga D" first="David P." last="Gierga">David P. Gierga</name>
<affiliation wicri:level="1"><nlm:aff id="aff1">Jason A. Efstathiou, David P. Gierga, Massachusetts General Hospital, Harvard Medical School; Scott Dryden-Peterson, Brigham and Women's Hospital, Boston, MA; Magda Heunis, University of Stellenbosch and Tygerberg Hospital, Cape Town, South Africa; Talkmore Karumekayi, Remigio Makufa, and Memory Bvochora-Nsingo, Gaborone Private Hospital; Joseph Kasese, Bokamoso Private Hospital; Mompati Mmalane, Joseph Makhema, and Scott Dryden-Peterson, Botswana Harvard AIDS Institute; Howard Moffat, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Huntsman Cancer Hospital, Salt Lake City, UT; Surbhi Grover, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and Alexander von Paleske, Mpilo-Hospital, University of Zimbabwe, Bulawayo, Zimbabwe.</nlm:aff>
<country xml:lang="fr" wicri:curation="lc">Zimbabwe</country>
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<wicri:noRegion>Bulawayo</wicri:noRegion>
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<author><name sortKey="Suneja, Gita" sort="Suneja, Gita" uniqKey="Suneja G" first="Gita" last="Suneja">Gita Suneja</name>
<affiliation wicri:level="1"><nlm:aff id="aff1">Jason A. Efstathiou, David P. Gierga, Massachusetts General Hospital, Harvard Medical School; Scott Dryden-Peterson, Brigham and Women's Hospital, Boston, MA; Magda Heunis, University of Stellenbosch and Tygerberg Hospital, Cape Town, South Africa; Talkmore Karumekayi, Remigio Makufa, and Memory Bvochora-Nsingo, Gaborone Private Hospital; Joseph Kasese, Bokamoso Private Hospital; Mompati Mmalane, Joseph Makhema, and Scott Dryden-Peterson, Botswana Harvard AIDS Institute; Howard Moffat, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Huntsman Cancer Hospital, Salt Lake City, UT; Surbhi Grover, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and Alexander von Paleske, Mpilo-Hospital, University of Zimbabwe, Bulawayo, Zimbabwe.</nlm:aff>
<country xml:lang="fr" wicri:curation="lc">Zimbabwe</country>
<wicri:regionArea>Jason A. Efstathiou, David P. Gierga, Massachusetts General Hospital, Harvard Medical School; Scott Dryden-Peterson, Brigham and Women's Hospital, Boston, MA; Magda Heunis, University of Stellenbosch and Tygerberg Hospital, Cape Town, South Africa; Talkmore Karumekayi, Remigio Makufa, and Memory Bvochora-Nsingo, Gaborone Private Hospital; Joseph Kasese, Bokamoso Private Hospital; Mompati Mmalane, Joseph Makhema, and Scott Dryden-Peterson, Botswana Harvard AIDS Institute; Howard Moffat, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Huntsman Cancer Hospital, Salt Lake City, UT; Surbhi Grover, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and Alexander von Paleske, Mpilo-Hospital, University of Zimbabwe, Bulawayo</wicri:regionArea>
<wicri:noRegion>Bulawayo</wicri:noRegion>
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<author><name sortKey="Grover, Surbhi" sort="Grover, Surbhi" uniqKey="Grover S" first="Surbhi" last="Grover">Surbhi Grover</name>
<affiliation wicri:level="1"><nlm:aff id="aff1">Jason A. Efstathiou, David P. Gierga, Massachusetts General Hospital, Harvard Medical School; Scott Dryden-Peterson, Brigham and Women's Hospital, Boston, MA; Magda Heunis, University of Stellenbosch and Tygerberg Hospital, Cape Town, South Africa; Talkmore Karumekayi, Remigio Makufa, and Memory Bvochora-Nsingo, Gaborone Private Hospital; Joseph Kasese, Bokamoso Private Hospital; Mompati Mmalane, Joseph Makhema, and Scott Dryden-Peterson, Botswana Harvard AIDS Institute; Howard Moffat, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Huntsman Cancer Hospital, Salt Lake City, UT; Surbhi Grover, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and Alexander von Paleske, Mpilo-Hospital, University of Zimbabwe, Bulawayo, Zimbabwe.</nlm:aff>
<country xml:lang="fr" wicri:curation="lc">Zimbabwe</country>
<wicri:regionArea>Jason A. Efstathiou, David P. Gierga, Massachusetts General Hospital, Harvard Medical School; Scott Dryden-Peterson, Brigham and Women's Hospital, Boston, MA; Magda Heunis, University of Stellenbosch and Tygerberg Hospital, Cape Town, South Africa; Talkmore Karumekayi, Remigio Makufa, and Memory Bvochora-Nsingo, Gaborone Private Hospital; Joseph Kasese, Bokamoso Private Hospital; Mompati Mmalane, Joseph Makhema, and Scott Dryden-Peterson, Botswana Harvard AIDS Institute; Howard Moffat, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Huntsman Cancer Hospital, Salt Lake City, UT; Surbhi Grover, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and Alexander von Paleske, Mpilo-Hospital, University of Zimbabwe, Bulawayo</wicri:regionArea>
<wicri:noRegion>Bulawayo</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Kasese, Joseph" sort="Kasese, Joseph" uniqKey="Kasese J" first="Joseph" last="Kasese">Joseph Kasese</name>
<affiliation wicri:level="1"><nlm:aff id="aff1">Jason A. Efstathiou, David P. Gierga, Massachusetts General Hospital, Harvard Medical School; Scott Dryden-Peterson, Brigham and Women's Hospital, Boston, MA; Magda Heunis, University of Stellenbosch and Tygerberg Hospital, Cape Town, South Africa; Talkmore Karumekayi, Remigio Makufa, and Memory Bvochora-Nsingo, Gaborone Private Hospital; Joseph Kasese, Bokamoso Private Hospital; Mompati Mmalane, Joseph Makhema, and Scott Dryden-Peterson, Botswana Harvard AIDS Institute; Howard Moffat, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Huntsman Cancer Hospital, Salt Lake City, UT; Surbhi Grover, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and Alexander von Paleske, Mpilo-Hospital, University of Zimbabwe, Bulawayo, Zimbabwe.</nlm:aff>
<country xml:lang="fr" wicri:curation="lc">Zimbabwe</country>
<wicri:regionArea>Jason A. Efstathiou, David P. Gierga, Massachusetts General Hospital, Harvard Medical School; Scott Dryden-Peterson, Brigham and Women's Hospital, Boston, MA; Magda Heunis, University of Stellenbosch and Tygerberg Hospital, Cape Town, South Africa; Talkmore Karumekayi, Remigio Makufa, and Memory Bvochora-Nsingo, Gaborone Private Hospital; Joseph Kasese, Bokamoso Private Hospital; Mompati Mmalane, Joseph Makhema, and Scott Dryden-Peterson, Botswana Harvard AIDS Institute; Howard Moffat, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Huntsman Cancer Hospital, Salt Lake City, UT; Surbhi Grover, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and Alexander von Paleske, Mpilo-Hospital, University of Zimbabwe, Bulawayo</wicri:regionArea>
<wicri:noRegion>Bulawayo</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Mmalane, Mompati" sort="Mmalane, Mompati" uniqKey="Mmalane M" first="Mompati" last="Mmalane">Mompati Mmalane</name>
<affiliation wicri:level="1"><nlm:aff id="aff1">Jason A. Efstathiou, David P. Gierga, Massachusetts General Hospital, Harvard Medical School; Scott Dryden-Peterson, Brigham and Women's Hospital, Boston, MA; Magda Heunis, University of Stellenbosch and Tygerberg Hospital, Cape Town, South Africa; Talkmore Karumekayi, Remigio Makufa, and Memory Bvochora-Nsingo, Gaborone Private Hospital; Joseph Kasese, Bokamoso Private Hospital; Mompati Mmalane, Joseph Makhema, and Scott Dryden-Peterson, Botswana Harvard AIDS Institute; Howard Moffat, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Huntsman Cancer Hospital, Salt Lake City, UT; Surbhi Grover, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and Alexander von Paleske, Mpilo-Hospital, University of Zimbabwe, Bulawayo, Zimbabwe.</nlm:aff>
<country xml:lang="fr" wicri:curation="lc">Zimbabwe</country>
<wicri:regionArea>Jason A. Efstathiou, David P. Gierga, Massachusetts General Hospital, Harvard Medical School; Scott Dryden-Peterson, Brigham and Women's Hospital, Boston, MA; Magda Heunis, University of Stellenbosch and Tygerberg Hospital, Cape Town, South Africa; Talkmore Karumekayi, Remigio Makufa, and Memory Bvochora-Nsingo, Gaborone Private Hospital; Joseph Kasese, Bokamoso Private Hospital; Mompati Mmalane, Joseph Makhema, and Scott Dryden-Peterson, Botswana Harvard AIDS Institute; Howard Moffat, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Huntsman Cancer Hospital, Salt Lake City, UT; Surbhi Grover, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and Alexander von Paleske, Mpilo-Hospital, University of Zimbabwe, Bulawayo</wicri:regionArea>
<wicri:noRegion>Bulawayo</wicri:noRegion>
</affiliation>
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<author><name sortKey="Moffat, Howard" sort="Moffat, Howard" uniqKey="Moffat H" first="Howard" last="Moffat">Howard Moffat</name>
<affiliation wicri:level="1"><nlm:aff id="aff1">Jason A. Efstathiou, David P. Gierga, Massachusetts General Hospital, Harvard Medical School; Scott Dryden-Peterson, Brigham and Women's Hospital, Boston, MA; Magda Heunis, University of Stellenbosch and Tygerberg Hospital, Cape Town, South Africa; Talkmore Karumekayi, Remigio Makufa, and Memory Bvochora-Nsingo, Gaborone Private Hospital; Joseph Kasese, Bokamoso Private Hospital; Mompati Mmalane, Joseph Makhema, and Scott Dryden-Peterson, Botswana Harvard AIDS Institute; Howard Moffat, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Huntsman Cancer Hospital, Salt Lake City, UT; Surbhi Grover, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and Alexander von Paleske, Mpilo-Hospital, University of Zimbabwe, Bulawayo, Zimbabwe.</nlm:aff>
<country xml:lang="fr" wicri:curation="lc">Zimbabwe</country>
<wicri:regionArea>Jason A. Efstathiou, David P. Gierga, Massachusetts General Hospital, Harvard Medical School; Scott Dryden-Peterson, Brigham and Women's Hospital, Boston, MA; Magda Heunis, University of Stellenbosch and Tygerberg Hospital, Cape Town, South Africa; Talkmore Karumekayi, Remigio Makufa, and Memory Bvochora-Nsingo, Gaborone Private Hospital; Joseph Kasese, Bokamoso Private Hospital; Mompati Mmalane, Joseph Makhema, and Scott Dryden-Peterson, Botswana Harvard AIDS Institute; Howard Moffat, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Huntsman Cancer Hospital, Salt Lake City, UT; Surbhi Grover, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and Alexander von Paleske, Mpilo-Hospital, University of Zimbabwe, Bulawayo</wicri:regionArea>
<wicri:noRegion>Bulawayo</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Von Paleske, Alexander" sort="Von Paleske, Alexander" uniqKey="Von Paleske A" first="Alexander" last="Von Paleske">Alexander Von Paleske</name>
<affiliation wicri:level="1"><nlm:aff id="aff1">Jason A. Efstathiou, David P. Gierga, Massachusetts General Hospital, Harvard Medical School; Scott Dryden-Peterson, Brigham and Women's Hospital, Boston, MA; Magda Heunis, University of Stellenbosch and Tygerberg Hospital, Cape Town, South Africa; Talkmore Karumekayi, Remigio Makufa, and Memory Bvochora-Nsingo, Gaborone Private Hospital; Joseph Kasese, Bokamoso Private Hospital; Mompati Mmalane, Joseph Makhema, and Scott Dryden-Peterson, Botswana Harvard AIDS Institute; Howard Moffat, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Huntsman Cancer Hospital, Salt Lake City, UT; Surbhi Grover, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and Alexander von Paleske, Mpilo-Hospital, University of Zimbabwe, Bulawayo, Zimbabwe.</nlm:aff>
<country xml:lang="fr" wicri:curation="lc">Zimbabwe</country>
<wicri:regionArea>Jason A. Efstathiou, David P. Gierga, Massachusetts General Hospital, Harvard Medical School; Scott Dryden-Peterson, Brigham and Women's Hospital, Boston, MA; Magda Heunis, University of Stellenbosch and Tygerberg Hospital, Cape Town, South Africa; Talkmore Karumekayi, Remigio Makufa, and Memory Bvochora-Nsingo, Gaborone Private Hospital; Joseph Kasese, Bokamoso Private Hospital; Mompati Mmalane, Joseph Makhema, and Scott Dryden-Peterson, Botswana Harvard AIDS Institute; Howard Moffat, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Huntsman Cancer Hospital, Salt Lake City, UT; Surbhi Grover, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and Alexander von Paleske, Mpilo-Hospital, University of Zimbabwe, Bulawayo</wicri:regionArea>
<wicri:noRegion>Bulawayo</wicri:noRegion>
</affiliation>
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<author><name sortKey="Makhema, Joseph" sort="Makhema, Joseph" uniqKey="Makhema J" first="Joseph" last="Makhema">Joseph Makhema</name>
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Establishing and Delivering Quality Radiation Therapy in Resource-Constrained Settings: The Story of Botswana</title>
<author><name sortKey="Efstathiou, Jason A" sort="Efstathiou, Jason A" uniqKey="Efstathiou J" first="Jason A." last="Efstathiou">Jason A. Efstathiou</name>
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<country xml:lang="fr" wicri:curation="lc">Zimbabwe</country>
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<wicri:noRegion>Bulawayo</wicri:noRegion>
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</author>
<author><name sortKey="Heunis, Magda" sort="Heunis, Magda" uniqKey="Heunis M" first="Magda" last="Heunis">Magda Heunis</name>
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<country xml:lang="fr" wicri:curation="lc">Zimbabwe</country>
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<author><name sortKey="Karumekayi, Talkmore" sort="Karumekayi, Talkmore" uniqKey="Karumekayi T" first="Talkmore" last="Karumekayi">Talkmore Karumekayi</name>
<affiliation wicri:level="1"><nlm:aff id="aff1">Jason A. Efstathiou, David P. Gierga, Massachusetts General Hospital, Harvard Medical School; Scott Dryden-Peterson, Brigham and Women's Hospital, Boston, MA; Magda Heunis, University of Stellenbosch and Tygerberg Hospital, Cape Town, South Africa; Talkmore Karumekayi, Remigio Makufa, and Memory Bvochora-Nsingo, Gaborone Private Hospital; Joseph Kasese, Bokamoso Private Hospital; Mompati Mmalane, Joseph Makhema, and Scott Dryden-Peterson, Botswana Harvard AIDS Institute; Howard Moffat, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Huntsman Cancer Hospital, Salt Lake City, UT; Surbhi Grover, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and Alexander von Paleske, Mpilo-Hospital, University of Zimbabwe, Bulawayo, Zimbabwe.</nlm:aff>
<country xml:lang="fr" wicri:curation="lc">Zimbabwe</country>
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<country xml:lang="fr" wicri:curation="lc">Zimbabwe</country>
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<author><name sortKey="Bvochora Nsingo, Memory" sort="Bvochora Nsingo, Memory" uniqKey="Bvochora Nsingo M" first="Memory" last="Bvochora-Nsingo">Memory Bvochora-Nsingo</name>
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<country xml:lang="fr" wicri:curation="lc">Zimbabwe</country>
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<author><name sortKey="Gierga, David P" sort="Gierga, David P" uniqKey="Gierga D" first="David P." last="Gierga">David P. Gierga</name>
<affiliation wicri:level="1"><nlm:aff id="aff1">Jason A. Efstathiou, David P. Gierga, Massachusetts General Hospital, Harvard Medical School; Scott Dryden-Peterson, Brigham and Women's Hospital, Boston, MA; Magda Heunis, University of Stellenbosch and Tygerberg Hospital, Cape Town, South Africa; Talkmore Karumekayi, Remigio Makufa, and Memory Bvochora-Nsingo, Gaborone Private Hospital; Joseph Kasese, Bokamoso Private Hospital; Mompati Mmalane, Joseph Makhema, and Scott Dryden-Peterson, Botswana Harvard AIDS Institute; Howard Moffat, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Huntsman Cancer Hospital, Salt Lake City, UT; Surbhi Grover, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and Alexander von Paleske, Mpilo-Hospital, University of Zimbabwe, Bulawayo, Zimbabwe.</nlm:aff>
<country xml:lang="fr" wicri:curation="lc">Zimbabwe</country>
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<author><name sortKey="Suneja, Gita" sort="Suneja, Gita" uniqKey="Suneja G" first="Gita" last="Suneja">Gita Suneja</name>
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<country xml:lang="fr" wicri:curation="lc">Zimbabwe</country>
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<author><name sortKey="Grover, Surbhi" sort="Grover, Surbhi" uniqKey="Grover S" first="Surbhi" last="Grover">Surbhi Grover</name>
<affiliation wicri:level="1"><nlm:aff id="aff1">Jason A. Efstathiou, David P. Gierga, Massachusetts General Hospital, Harvard Medical School; Scott Dryden-Peterson, Brigham and Women's Hospital, Boston, MA; Magda Heunis, University of Stellenbosch and Tygerberg Hospital, Cape Town, South Africa; Talkmore Karumekayi, Remigio Makufa, and Memory Bvochora-Nsingo, Gaborone Private Hospital; Joseph Kasese, Bokamoso Private Hospital; Mompati Mmalane, Joseph Makhema, and Scott Dryden-Peterson, Botswana Harvard AIDS Institute; Howard Moffat, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Huntsman Cancer Hospital, Salt Lake City, UT; Surbhi Grover, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and Alexander von Paleske, Mpilo-Hospital, University of Zimbabwe, Bulawayo, Zimbabwe.</nlm:aff>
<country xml:lang="fr" wicri:curation="lc">Zimbabwe</country>
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<author><name sortKey="Kasese, Joseph" sort="Kasese, Joseph" uniqKey="Kasese J" first="Joseph" last="Kasese">Joseph Kasese</name>
<affiliation wicri:level="1"><nlm:aff id="aff1">Jason A. Efstathiou, David P. Gierga, Massachusetts General Hospital, Harvard Medical School; Scott Dryden-Peterson, Brigham and Women's Hospital, Boston, MA; Magda Heunis, University of Stellenbosch and Tygerberg Hospital, Cape Town, South Africa; Talkmore Karumekayi, Remigio Makufa, and Memory Bvochora-Nsingo, Gaborone Private Hospital; Joseph Kasese, Bokamoso Private Hospital; Mompati Mmalane, Joseph Makhema, and Scott Dryden-Peterson, Botswana Harvard AIDS Institute; Howard Moffat, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Huntsman Cancer Hospital, Salt Lake City, UT; Surbhi Grover, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and Alexander von Paleske, Mpilo-Hospital, University of Zimbabwe, Bulawayo, Zimbabwe.</nlm:aff>
<country xml:lang="fr" wicri:curation="lc">Zimbabwe</country>
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<author><name sortKey="Mmalane, Mompati" sort="Mmalane, Mompati" uniqKey="Mmalane M" first="Mompati" last="Mmalane">Mompati Mmalane</name>
<affiliation wicri:level="1"><nlm:aff id="aff1">Jason A. Efstathiou, David P. Gierga, Massachusetts General Hospital, Harvard Medical School; Scott Dryden-Peterson, Brigham and Women's Hospital, Boston, MA; Magda Heunis, University of Stellenbosch and Tygerberg Hospital, Cape Town, South Africa; Talkmore Karumekayi, Remigio Makufa, and Memory Bvochora-Nsingo, Gaborone Private Hospital; Joseph Kasese, Bokamoso Private Hospital; Mompati Mmalane, Joseph Makhema, and Scott Dryden-Peterson, Botswana Harvard AIDS Institute; Howard Moffat, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Huntsman Cancer Hospital, Salt Lake City, UT; Surbhi Grover, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and Alexander von Paleske, Mpilo-Hospital, University of Zimbabwe, Bulawayo, Zimbabwe.</nlm:aff>
<country xml:lang="fr" wicri:curation="lc">Zimbabwe</country>
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<author><name sortKey="Moffat, Howard" sort="Moffat, Howard" uniqKey="Moffat H" first="Howard" last="Moffat">Howard Moffat</name>
<affiliation wicri:level="1"><nlm:aff id="aff1">Jason A. Efstathiou, David P. Gierga, Massachusetts General Hospital, Harvard Medical School; Scott Dryden-Peterson, Brigham and Women's Hospital, Boston, MA; Magda Heunis, University of Stellenbosch and Tygerberg Hospital, Cape Town, South Africa; Talkmore Karumekayi, Remigio Makufa, and Memory Bvochora-Nsingo, Gaborone Private Hospital; Joseph Kasese, Bokamoso Private Hospital; Mompati Mmalane, Joseph Makhema, and Scott Dryden-Peterson, Botswana Harvard AIDS Institute; Howard Moffat, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Huntsman Cancer Hospital, Salt Lake City, UT; Surbhi Grover, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and Alexander von Paleske, Mpilo-Hospital, University of Zimbabwe, Bulawayo, Zimbabwe.</nlm:aff>
<country xml:lang="fr" wicri:curation="lc">Zimbabwe</country>
<wicri:regionArea>Jason A. Efstathiou, David P. Gierga, Massachusetts General Hospital, Harvard Medical School; Scott Dryden-Peterson, Brigham and Women's Hospital, Boston, MA; Magda Heunis, University of Stellenbosch and Tygerberg Hospital, Cape Town, South Africa; Talkmore Karumekayi, Remigio Makufa, and Memory Bvochora-Nsingo, Gaborone Private Hospital; Joseph Kasese, Bokamoso Private Hospital; Mompati Mmalane, Joseph Makhema, and Scott Dryden-Peterson, Botswana Harvard AIDS Institute; Howard Moffat, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Huntsman Cancer Hospital, Salt Lake City, UT; Surbhi Grover, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and Alexander von Paleske, Mpilo-Hospital, University of Zimbabwe, Bulawayo</wicri:regionArea>
<wicri:noRegion>Bulawayo</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Von Paleske, Alexander" sort="Von Paleske, Alexander" uniqKey="Von Paleske A" first="Alexander" last="Von Paleske">Alexander Von Paleske</name>
<affiliation wicri:level="1"><nlm:aff id="aff1">Jason A. Efstathiou, David P. Gierga, Massachusetts General Hospital, Harvard Medical School; Scott Dryden-Peterson, Brigham and Women's Hospital, Boston, MA; Magda Heunis, University of Stellenbosch and Tygerberg Hospital, Cape Town, South Africa; Talkmore Karumekayi, Remigio Makufa, and Memory Bvochora-Nsingo, Gaborone Private Hospital; Joseph Kasese, Bokamoso Private Hospital; Mompati Mmalane, Joseph Makhema, and Scott Dryden-Peterson, Botswana Harvard AIDS Institute; Howard Moffat, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Huntsman Cancer Hospital, Salt Lake City, UT; Surbhi Grover, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and Alexander von Paleske, Mpilo-Hospital, University of Zimbabwe, Bulawayo, Zimbabwe.</nlm:aff>
<country xml:lang="fr" wicri:curation="lc">Zimbabwe</country>
<wicri:regionArea>Jason A. Efstathiou, David P. Gierga, Massachusetts General Hospital, Harvard Medical School; Scott Dryden-Peterson, Brigham and Women's Hospital, Boston, MA; Magda Heunis, University of Stellenbosch and Tygerberg Hospital, Cape Town, South Africa; Talkmore Karumekayi, Remigio Makufa, and Memory Bvochora-Nsingo, Gaborone Private Hospital; Joseph Kasese, Bokamoso Private Hospital; Mompati Mmalane, Joseph Makhema, and Scott Dryden-Peterson, Botswana Harvard AIDS Institute; Howard Moffat, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Huntsman Cancer Hospital, Salt Lake City, UT; Surbhi Grover, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and Alexander von Paleske, Mpilo-Hospital, University of Zimbabwe, Bulawayo</wicri:regionArea>
<wicri:noRegion>Bulawayo</wicri:noRegion>
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<author><name sortKey="Makhema, Joseph" sort="Makhema, Joseph" uniqKey="Makhema J" first="Joseph" last="Makhema">Joseph Makhema</name>
<affiliation wicri:level="1"><nlm:aff id="aff1">Jason A. Efstathiou, David P. Gierga, Massachusetts General Hospital, Harvard Medical School; Scott Dryden-Peterson, Brigham and Women's Hospital, Boston, MA; Magda Heunis, University of Stellenbosch and Tygerberg Hospital, Cape Town, South Africa; Talkmore Karumekayi, Remigio Makufa, and Memory Bvochora-Nsingo, Gaborone Private Hospital; Joseph Kasese, Bokamoso Private Hospital; Mompati Mmalane, Joseph Makhema, and Scott Dryden-Peterson, Botswana Harvard AIDS Institute; Howard Moffat, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Huntsman Cancer Hospital, Salt Lake City, UT; Surbhi Grover, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and Alexander von Paleske, Mpilo-Hospital, University of Zimbabwe, Bulawayo, Zimbabwe.</nlm:aff>
<country xml:lang="fr" wicri:curation="lc">Zimbabwe</country>
<wicri:regionArea>Jason A. Efstathiou, David P. Gierga, Massachusetts General Hospital, Harvard Medical School; Scott Dryden-Peterson, Brigham and Women's Hospital, Boston, MA; Magda Heunis, University of Stellenbosch and Tygerberg Hospital, Cape Town, South Africa; Talkmore Karumekayi, Remigio Makufa, and Memory Bvochora-Nsingo, Gaborone Private Hospital; Joseph Kasese, Bokamoso Private Hospital; Mompati Mmalane, Joseph Makhema, and Scott Dryden-Peterson, Botswana Harvard AIDS Institute; Howard Moffat, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Huntsman Cancer Hospital, Salt Lake City, UT; Surbhi Grover, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and Alexander von Paleske, Mpilo-Hospital, University of Zimbabwe, Bulawayo</wicri:regionArea>
<wicri:noRegion>Bulawayo</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Dryden Peterson, Scott" sort="Dryden Peterson, Scott" uniqKey="Dryden Peterson S" first="Scott" last="Dryden-Peterson">Scott Dryden-Peterson</name>
<affiliation wicri:level="1"><nlm:aff id="aff1">Jason A. Efstathiou, David P. Gierga, Massachusetts General Hospital, Harvard Medical School; Scott Dryden-Peterson, Brigham and Women's Hospital, Boston, MA; Magda Heunis, University of Stellenbosch and Tygerberg Hospital, Cape Town, South Africa; Talkmore Karumekayi, Remigio Makufa, and Memory Bvochora-Nsingo, Gaborone Private Hospital; Joseph Kasese, Bokamoso Private Hospital; Mompati Mmalane, Joseph Makhema, and Scott Dryden-Peterson, Botswana Harvard AIDS Institute; Howard Moffat, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Huntsman Cancer Hospital, Salt Lake City, UT; Surbhi Grover, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and Alexander von Paleske, Mpilo-Hospital, University of Zimbabwe, Bulawayo, Zimbabwe.</nlm:aff>
<country xml:lang="fr" wicri:curation="lc">Zimbabwe</country>
<wicri:regionArea>Jason A. Efstathiou, David P. Gierga, Massachusetts General Hospital, Harvard Medical School; Scott Dryden-Peterson, Brigham and Women's Hospital, Boston, MA; Magda Heunis, University of Stellenbosch and Tygerberg Hospital, Cape Town, South Africa; Talkmore Karumekayi, Remigio Makufa, and Memory Bvochora-Nsingo, Gaborone Private Hospital; Joseph Kasese, Bokamoso Private Hospital; Mompati Mmalane, Joseph Makhema, and Scott Dryden-Peterson, Botswana Harvard AIDS Institute; Howard Moffat, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Huntsman Cancer Hospital, Salt Lake City, UT; Surbhi Grover, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and Alexander von Paleske, Mpilo-Hospital, University of Zimbabwe, Bulawayo</wicri:regionArea>
<wicri:noRegion>Bulawayo</wicri:noRegion>
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<series><title level="j">Journal of Clinical Oncology</title>
<idno type="ISSN">0732-183X</idno>
<idno type="eISSN">1527-7755</idno>
<imprint><date when="2015">2015</date>
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<front><div type="abstract" xml:lang="en"><p>There is a global cancer crisis, and it is disproportionately affecting resource-constrained settings, especially in low- and middle-income countries (LMICs). Radiotherapy is a critical and cost-effective component of a comprehensive cancer control plan that offers the potential for cure, control, and palliation of disease in greater than 50% of patients with cancer. Globally, LMICs do not have adequate access to quality radiation therapy and this gap is particularly pronounced in sub-Saharan Africa. Although there are numerous challenges in implementing a radiation therapy program in a low-resource setting, providing more equitable global access to radiotherapy is a responsibility and investment worth prioritizing. We outline a systems approach and a series of key questions to direct strategy toward establishing quality radiation services in LMICs, and highlight the story of private-public investment in Botswana from the late 1990s to the present. After assessing the need and defining the value of radiation, we explore core investments required, barriers that need to be overcome, and assets that can be leveraged to establish a radiation program. Considerations addressed include infrastructure; machine choice; quality assurance and patient safety; acquisition, development, and retention of human capital; governmental engagement; public–private partnerships; international collaborations; and the need to critically evaluate the program to foster further growth and sustainability.</p>
</div>
</front>
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<pmc article-type="review-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<front><journal-meta><journal-id journal-id-type="nlm-ta">J Clin Oncol</journal-id>
<journal-id journal-id-type="iso-abbrev">J. Clin. Oncol</journal-id>
<journal-id journal-id-type="hwp">jco</journal-id>
<journal-id journal-id-type="pmc">jco</journal-id>
<journal-id journal-id-type="publisher-id">JCO</journal-id>
<journal-title-group><journal-title>Journal of Clinical Oncology</journal-title>
</journal-title-group>
<issn pub-type="ppub">0732-183X</issn>
<issn pub-type="epub">1527-7755</issn>
<publisher><publisher-name>American Society of Clinical Oncology</publisher-name>
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<article-meta><article-id pub-id-type="pmid">26578607</article-id>
<article-id pub-id-type="pmc">5070566</article-id>
<article-id pub-id-type="publisher-id">628412</article-id>
<article-id pub-id-type="doi">10.1200/JCO.2015.62.8412</article-id>
<article-categories><subj-group subj-group-type="hwp-journal-coll"><subject>Radn</subject>
</subj-group>
<subj-group subj-group-type="heading"><subject>REVIEW ARTICLES</subject>
<subj-group><subject>Radiation Oncology</subject>
</subj-group>
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<title-group><article-title>Establishing and Delivering Quality Radiation Therapy in Resource-Constrained Settings: The Story of Botswana</article-title>
<alt-title alt-title-type="short">Radiation Therapy in Resource-Constrained Settings</alt-title>
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<contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Efstathiou</surname>
<given-names>Jason A.</given-names>
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<xref ref-type="aff" rid="aff1"></xref>
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<contrib contrib-type="author"><name><surname>Heunis</surname>
<given-names>Magda</given-names>
</name>
<xref ref-type="aff" rid="aff1"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Karumekayi</surname>
<given-names>Talkmore</given-names>
</name>
<xref ref-type="aff" rid="aff1"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Makufa</surname>
<given-names>Remigio</given-names>
</name>
<xref ref-type="aff" rid="aff1"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Bvochora-Nsingo</surname>
<given-names>Memory</given-names>
</name>
<xref ref-type="aff" rid="aff1"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Gierga</surname>
<given-names>David P.</given-names>
</name>
<xref ref-type="aff" rid="aff1"></xref>
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<contrib contrib-type="author"><name><surname>Suneja</surname>
<given-names>Gita</given-names>
</name>
<xref ref-type="aff" rid="aff1"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Grover</surname>
<given-names>Surbhi</given-names>
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<xref ref-type="aff" rid="aff1"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Kasese</surname>
<given-names>Joseph</given-names>
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<xref ref-type="aff" rid="aff1"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Mmalane</surname>
<given-names>Mompati</given-names>
</name>
<xref ref-type="aff" rid="aff1"></xref>
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<contrib contrib-type="author"><name><surname>Moffat</surname>
<given-names>Howard</given-names>
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<xref ref-type="aff" rid="aff1"></xref>
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<contrib contrib-type="author"><name><surname>von Paleske</surname>
<given-names>Alexander</given-names>
</name>
<xref ref-type="aff" rid="aff1"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Makhema</surname>
<given-names>Joseph</given-names>
</name>
<xref ref-type="aff" rid="aff1"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Dryden-Peterson</surname>
<given-names>Scott</given-names>
</name>
<xref ref-type="aff" rid="aff1"></xref>
</contrib>
<aff id="aff1">Jason A. Efstathiou, David P. Gierga, Massachusetts General Hospital, Harvard Medical School; Scott Dryden-Peterson, Brigham and Women's Hospital, Boston, MA; Magda Heunis, University of Stellenbosch and Tygerberg Hospital, Cape Town, South Africa; Talkmore Karumekayi, Remigio Makufa, and Memory Bvochora-Nsingo, Gaborone Private Hospital; Joseph Kasese, Bokamoso Private Hospital; Mompati Mmalane, Joseph Makhema, and Scott Dryden-Peterson, Botswana Harvard AIDS Institute; Howard Moffat, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Huntsman Cancer Hospital, Salt Lake City, UT; Surbhi Grover, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and Alexander von Paleske, Mpilo-Hospital, University of Zimbabwe, Bulawayo, Zimbabwe.</aff>
</contrib-group>
<author-notes><corresp id="cor1">Corresponding author: Jason A. Efstathiou, MD, DPhil, Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, 100 Blossom St, Cox 3, Boston, MA 02114; e-mail: <email>jefstathiou@partners.org</email>
.</corresp>
</author-notes>
<pub-date pub-type="ppub"><month>1</month>
<year>2016</year>
</pub-date>
<pub-date pub-type="epub"><day>16</day>
<month>11</month>
<year>2015</year>
</pub-date>
<pub-date pub-type="pmc-release"><day>1</day>
<month>4</month>
<year>2016</year>
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<pmc-comment> PMC Release delay is 3 months and
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<volume>34</volume>
<issue>1</issue>
<fpage>27</fpage>
<lpage>35</lpage>
<permissions><copyright-statement>© 2015 by American Society of Clinical Oncology</copyright-statement>
<copyright-year>2015</copyright-year>
<copyright-holder>American Society of Clinical Oncology</copyright-holder>
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<abstract><p>There is a global cancer crisis, and it is disproportionately affecting resource-constrained settings, especially in low- and middle-income countries (LMICs). Radiotherapy is a critical and cost-effective component of a comprehensive cancer control plan that offers the potential for cure, control, and palliation of disease in greater than 50% of patients with cancer. Globally, LMICs do not have adequate access to quality radiation therapy and this gap is particularly pronounced in sub-Saharan Africa. Although there are numerous challenges in implementing a radiation therapy program in a low-resource setting, providing more equitable global access to radiotherapy is a responsibility and investment worth prioritizing. We outline a systems approach and a series of key questions to direct strategy toward establishing quality radiation services in LMICs, and highlight the story of private-public investment in Botswana from the late 1990s to the present. After assessing the need and defining the value of radiation, we explore core investments required, barriers that need to be overcome, and assets that can be leveraged to establish a radiation program. Considerations addressed include infrastructure; machine choice; quality assurance and patient safety; acquisition, development, and retention of human capital; governmental engagement; public–private partnerships; international collaborations; and the need to critically evaluate the program to foster further growth and sustainability.</p>
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<name sortKey="Gierga, David P" sort="Gierga, David P" uniqKey="Gierga D" first="David P." last="Gierga">David P. Gierga</name>
<name sortKey="Grover, Surbhi" sort="Grover, Surbhi" uniqKey="Grover S" first="Surbhi" last="Grover">Surbhi Grover</name>
<name sortKey="Heunis, Magda" sort="Heunis, Magda" uniqKey="Heunis M" first="Magda" last="Heunis">Magda Heunis</name>
<name sortKey="Karumekayi, Talkmore" sort="Karumekayi, Talkmore" uniqKey="Karumekayi T" first="Talkmore" last="Karumekayi">Talkmore Karumekayi</name>
<name sortKey="Kasese, Joseph" sort="Kasese, Joseph" uniqKey="Kasese J" first="Joseph" last="Kasese">Joseph Kasese</name>
<name sortKey="Makhema, Joseph" sort="Makhema, Joseph" uniqKey="Makhema J" first="Joseph" last="Makhema">Joseph Makhema</name>
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