Speaker
Description
Introduction: Cancer has been increasingly become a burden in the world, particularly in developing countries such as Indonesia. Based on GLOBOCAN 2018, Indonesia cancer cases is expected to rise from 348,809 to 575,814 in 2040 or a 65.1% increase. Moreover, cancer attributable deaths will also spike up 76.9% from 207,210 to 366,567 deaths in 2040. Out of those number, the five most prevalent cases are breast, cervix uteri, lung, colorectum and liver. There are three mainstay treatments for cancer, including surgery, radiotherapy and chemotherapy. As one of the mainstay treatments, radiotherapy is an essential part of cancer management. It is estimated that around 50% of cancer patients need this type of treatment. Looking into the number of cancer cases in 2018, around 174 thousand cancer patients need radiation therapy. This number of cancer cases can be translated into 343 machines needed for the treatment of cancer using conventional fractionation. Using hypofractionation strategy, it is estimated that 268 teletherapy machines are needed. Talking about teletherapy machines needed per million population, Indonesia with over 270 million population, if 1 MV is needed for every 1 million population, 270 teletherapy machines are needed to ensure radiation treatment for every Indonesian citizen. Currently, RT machines available across the country only covered 34.7% of the country’s needs (using hypofractionation strategy). This study aims to present the reflection on Indonesian Radiation Oncology Society (IROS) national roadmap program to close the gap of radiotherapy services in Indonesia.
Methodology: Roadmap of Indonesia radiotherapy services were established in 2010 for the escalation of radiotherapy services. Moreover, this roadmap was updated every 5 year to calculate the accomplishment of the projected outcome. Further update is conducted in certain year whenever needed, especially if newest available data is needed for advocacies.
Results: These 5 yearly programs were divided into 9 different regions in Indonesia, each consisted of several provinces with different aims on the number of teletherapies needed. The rationalization on calculating the number needed are based on the number of populations, developing and archipelagic setting of the country, integration with national cancer control plan, cancer awareness among citizen, health promotion and continuing medical education for health professionals (especially oncologists). Multidisciplinary approach and guideline should also be obeyed by all oncologists to increase the utility of radiation therapy. Due to the circumstances that not all the criteria are able to be fulfilled, the society decided that this program aims to achieve 189 teletherapy machines by the end of 2035, or around 70% of 268 machines needed based on hypofractionation strategy calculation.
Currently, this program has reached the second 5-yearly evaluation. By the end of 2020, is is projected that 94 RT machines will be available in Indonesia with five out of nine regions that have fulfilled the target needed by 2020. From table 1, we can see that most teletherapies are available in region 3 (DKI Jakarta, West Java and Banten) and region 4 (Central Java and Jogjakarta). However, despite being set up from 2010, there is one region (Maluku and Papua) which has no teletherapies at all.
Conclusion: Cancer is an emerging problem in Indonesia. Radiation therapy plays a great role as one of the mainstay treatments for cancer, but the number of teletherapies is far from the needs. IROS has set up the 5-yearly roadmap for radiotherapy from 2010 to 2035 to scale up and fulfill the demand. By the end of 2020, some region is expected to meet the radiotherapy demand for the second program, but efforts are needed for the rest of the region, especially in the East part of Indonesia. To fill up the disparities across countries, multiple advocacies from the society to national and local government or private sectors have been conducted. This roadmap of radiotherapy has been given to the stakeholders in the Ministry of Health and incorporated into the National Cancer Control Plan (2015-2019). Further set up of the radiotherapy program has also been done with private hospitals or investors through public-private partnership framework (build operate transfer or joint cooperation). Additionally, to increase the utility of radiotherapy, setting up radiotherapy program should integrate multidiscipline and involve stakeholders. Nevertheless, in 2020, due to the pandemic problem of COVID-19 infection across the country, there might be some delay in fulfilling the demand of radiotherapy services in Indonesia.
| Country or Int. Organization | Indonesia |
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| Affiliation | Faculty of Medicine, Universitas Indonesia – Department of Radiation Oncology, Dr. Cipto Mangunkusumo National General Hospital – Jakarta, Indonesia |
