"Radiotherapy, which is used in the treatment of over 50% of cancer patients, is not available in many LMICs. Hence, in Africa for example, many people directly associate cancer with death," explained Wilfred Ngwa from the Dana Farber Cancer Institute, Brigham and Women's Hospital and Harvard Medical School. "Those who can afford therapy may have to trek hundreds of miles to a centre with radiotherapy services, and then they have unbelievable long waiting times. With many LMICs increasingly able to deal with diseases like malaria and HIV/AIDS, and people live longer, cancer is now emerging as a leading cause of death."

To address such inequalities in radiotherapy provision, Ngwa and other experts came together at the 2014 AAPM Annual Meeting to discuss how medical physicists and other radiation oncology professionals can collaborate across institutions. The group has now published the findings from this International Medical Physics Symposium (Int. J. Radiat. Oncol. Biol. Phys. 91 444).

Catalysing collaboration

Ngwa and co-authors point out that although radiation oncology professionals are showing an increased interest in global health issues, they often do not know how to participate. There's a real need for some sort of platform to bring potential collaborators together and convert this upsurge of interest into action. "Very few such collaborations exist in radiation oncology at this time," Ngwa noted.

One option proposed at the AAPM symposium is to develop something along the lines of the Harvard Catalyst model, which enables collaboration among 31 affiliated institutions, hospitals and community partners. A similar platform could allow the creation of high-impact global health collaborations focused on radiation therapy. Such a global health catalyst (GHC) could enable institutions from different nations and diverse economic backgrounds to work together on activities in clinical radiotherapy, as well as research and education.

"We believe that this approach would make it significantly easier to collaborate," Ngwa told medicalphysicsweb. "Indeed, the feedback for this approach has been overwhelmingly positive and constructive, including reviewer comments on our Red Journal article, discussions at the AAPM symposium with speakers/panellists Thomas Bortfeld (MGH), Twalib Ngoma (ORCI, Tanzania), Babatope Akinwande (IAEA), Erno Sajo (University of Massachusetts) and Raymond Wu (IOMP), and feedback from presentations given elsewhere."

Technology driven

In particular, the group is examining the use of information and communication technologies (ICTs) – tools for electronic data capture, processing, storage and exchange – to enable such GHCs. If well implemented, these projects could have an immediate impact with minimal investment in time and effort.

Ngwa described some recent ICT developments that could help collaborative projects achieve things that they couldn't do previously. One example is VelocityGRID, a cloud-based image exchange platform that allows remote and secure collaboration on a patient's treatment planning, evaluation and delivery, across institutions or countries. Advanced technologies such as Google Glass and FaceTime, meanwhile, could allow remote support of radiotherapy system quality assurance, lowering maintenance costs and minimizing machine downtime – a major issue for many LMICs.

Another emerging possibility is the use of mobile devices to collect and securely transmit patient data for remote interpretation or evaluation. "Interestingly, people in LMICs may have limited money but they often have mobile phones," said Ngwa. "Recently developed Apps can be employed for education and training."

Other educational approaches include the use of EdX, which provides free online courses and classes. A GHC could incorporate e-learning to enable space-time flexible teaching, for example, or provide low-cost access to continuing education. GHC-supported practical training workshops, for example over the summer, could complement e-learning, workforce development and increase training and education quality. Such capacity building is crucial to strengthen the healthcare system and a pre-requisite for establishing any radiotherapy services in some LMICs.

For cancer research applications, a GHC platform could help investigators more easily find collaborators or mentors across multinational institutions, using facilities such as the open-source Profiles software. ICTs such as the video-conferencing software WebEx can enable remote participation at conferences, providing further opportunities for nurturing scientific collaborations.

Finally, the GHC could also incorporate funding approaches such as crowdfunding. This could allow, for example, a US investigator to partner with an investigator in Tanzania to get crowdfunding from diaspora groups to perform joint research projects. The potential impact could be huge for investigators in many LMICs who otherwise have little or no funding, and where relatively modest funds could enable many years of fruitful research.

Ngwa and colleagues are currently completing tests on a beta version of the GHC platform. "We anticipate that the first GHC-supported collaboration projects will fully take off in 2015," he said. "These will include projects within education (e-learning), research (with pilot funding and crowdfunding from diaspora groups) and collaborative cancer care with an initial focus on catalysing collaborations with LMICs in Africa."

In the meantime, they are looking to secure further funding to scale-up and subsequently reach other LMICs beyond Africa. "We envision this developing into one of the most concerted actions yet to eliminate global health disparities in radiation oncology care, research and education, while also helping to broaden the learning and international experience of medical physicists from developed countries," said Ngwa.