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Multi-component health system interventions improve access to external beam radiotherapy in low and middle income countriesHealth System Changes Improve Access to Radiation Therapy

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Key Takeaway
Note that multi-component health system interventions can improve radiotherapy utilization and reduce waiting times.

This scoping review synthesized 31 studies regarding health system interventions aimed at improving access to external beam radiotherapy (EBRT) in global health systems, specifically within low- and middle-income countries. The review identified several key intervention types: infrastructure expansion (45%), workforce development (35%), operational redesign (29%), telemedicine (26%), referral and navigation (19%), and financial reforms (10%).

The authors synthesized evidence indicating that the majority of studies reported positive outcomes, including improved radiotherapy utilization, reduced waiting times, and higher treatment completion rates. These findings suggest that multi-component programs integrating infrastructure, workforce development, operational redesign, tele-radiotherapy, decentralization through hub-and-spoke models, and hypofractionation protocolization are sustainable strategies for improving EBRT access.

Limitations noted by the authors include a lack of standardized access metrics in current research and a lack of equity-stratified outcomes in existing reports. Clinical application should be interpreted with caution as the findings are based on a scoping review of existing literature rather than primary clinical trials. The evidence suggests that integrated systemic changes may improve patient access to radiotherapy, but specific impact magnitudes were not reported.

A review of 31 different studies looked at how health systems can improve access to external beam radiotherapy (EBRT). This type of radiation is a common treatment for many conditions. The researchers focused on what happens when hospitals and clinics change their ways to reach more patients, especially in lower-income regions.

The study found that several types of changes helped. These included building better infrastructure, training more workers, and redesigning how clinics operate. Other methods like using telemedicine, creating better referral systems, and making financial reforms also showed promise. Most studies reported that these changes led to more people using radiation therapy, shorter waiting times, and higher rates of patients finishing their full treatment plans.

Because this was a scoping review of existing research rather than a new clinical trial, the results show links between these programs and better access. The study also noted that current research lacks some standard ways to measure equity. These findings suggest that combining many different strategies can help create more sustainable ways for patients to receive necessary care.

What this means for you:
Combining infrastructure, staff training, and new technology can improve radiation therapy access and completion rates.

Common questions

What types of changes help patients get radiation treatment?

Several different strategies were identified. These include expanding physical infrastructure, developing the workforce, redesigning operations, and using telemedicine. Other methods like improving referral systems and making financial reforms also contribute to better access for patients needing external beam radiotherapy.

How do these changes affect patient care?

The majority of studies reported that these interventions led to positive outcomes. Specifically, they found improved radiation therapy utilization, shorter waiting times for patients, and higher rates of treatment completion. These results suggest that system-wide changes can help more people finish their full courses of care.

What are the main strategies for sustainable access?

The review identified multi-component programs as a sustainable way to improve access. These include combining infrastructure, workforce development, and operational redesign with technologies like tele-radiotherapy and decentralized hub-and-spoke models to reach more patients.

Study Details

Study typeSystematic review
EvidenceLevel 1
PublishedJun 2026
View Original Abstract ↓
Access to external beam radiotherapy (EBRT) remains heterogeneous across global health systems, particularly in low- and middle-income countries (LMIC). This scoping review aimed to synthesize evidence on health-system interventions intended to improve EBRT access, characterize their outcomes, and identify promising strategies for sustainable and equitable radiotherapy delivery. A systematic search of Ovid MEDLINE, Embase, and CINAHL from inception to June 30, 2025, identified studies evaluating system-level interventions to improve EBRT access. Eligible interventions included infrastructure expansion, workforce development, operational redesign, telemedicine, financing, and quality improvement initiatives. Data were extracted in duplicate and narratively synthesized by intervention domain. Across 31 included studies, the most frequent intervention domains were infrastructure expansion (45%), workforce development (35%), operational redesign (29%), telemedicine (26%), referral and navigation (19%), and financial reforms (10%). The majority of studies reported improved radiotherapy utilization, reduced waiting times, and higher treatment completion rates. Multi-component programs that integrate interventions such as infrastructure and workforce expansion, operational redesign, tele-radiotherapy, decentralization through hub-and-spoke models, and protocolization of hypofractionation regimens, workforce, and operational redesign, can be a sustainable strategy to progress towards equitable, system-level programs to improve EBRT access. Health-system interventions can meaningfully expand access to EBRT when they align investments in infrastructure, workforce, and operations. Multi-component, equity-focused strategies hold promise for scalable, high-quality radiotherapy delivery to address access disparities. Future research should adopt standardized access metrics and report equity-stratified outcomes to guide national strategies for sustainable scale-up of EBRT.
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