Global Health in Radiation Oncology: The Emergence of a New Career Pathway

The massive global shortfall in radiotherapy equipment and human resources in developing countries is an enormous challenge for international efforts in cancer control. This lack of access to treatment has been long-standing, but there is now a growing consensus about the urgent need to prioritize solutions to this problem and that a global strategy is required for them to be successful. An essential element of making radiotherapy universally accessible is a coordinated approach to clinical training and practice. This has been recently recognized by many university departments and clinical training programs. However, formalized training and career promotion tracks in global health within radiation oncology have been slow to emerge, thereby limiting the sustained involvement of students and faculty, and restricting opportunities for leadership in this space. We examine here potential structures and benefits of formalized global health training in radiation oncology. We explore how defining specific competencies in this area can help trainees and practitioners integrate their activities in global health within their existing roles as clinicians, educators, or scientists. This would also help create a new global health track for academic advancement, which could focus on such domains as implementation science, health service, and advocacy. We discuss how effective mentorship models, international partnerships, and institutional twinning arrangements support this work and explore how new resources and funding models might be used to further develop and expand radiation oncology services globally.

Introduction

Globalization is a modern phenomenon that is perhaps most evident in the interconnectedness of economies and in the global transmission of disease. The field of global health broadly refers to a perspective on health that extends beyond local and national boundaries and includes the goal of resolving problems that are beyond the capacity of any single nation to address.¹ This field implies a shared responsibility for human welfare and the recognition that the welfare and health of nations and individuals across the globe are inextricably linked.

Only recently has a global health perspective emerged in radiation oncology. In a 2006 article, the potential value of cross-national partnerships in introducing radiotherapy into lower income countries was recognized.² Since that time, there has been growing recognition of the need for radiotherapy to be available in these regions to combat the increasing burden of cancer mortality and morbidity in these populations, and of the potential power of international partnerships to make this happen. The Global Task Force on Radiotherapy for Cancer Control (GTFRCC) of the Union for International Cancer Control (UICC), made up of over 100 members from the fields of oncology, industry, global health, and economics, was created to develop an organized international response to this challenge.³ The GTFRCC, which provided a roadmap for radiotherapy to be introduced into low- and middle-income countries (LMICs),⁴ is a potential model for the global application of expertise in radiotherapy to the problem of cancer control. Inherent in this expansion is the need for a large number of skilled individuals to deliver radiotherapy treatments.

The efforts of the GTFRCC and the interest that it has generated are encouraging, but also points to the need for an enduring global health perspective in radiation oncology, an essential long-term component of overall cancer care. Sustained development of this focus in radiation oncology requires an organized approach to recruitment and training in this field. We will consider here current global health training and career opportunities in radiation oncology and what strategies are needed to enhance and formalize such opportunities.