By Kim Furlow, Institute for Public Health
On Tuesday, March 23, the Global Health Center invites you to an informative webinar organized by Varian with Radiation Oncologists Hiram Gay, MD and Edgar Ruiz, MD to learn how the Guatemalan National Cancer League made the technological leap from Cobalt-60 to Halcyon™ system and is now serving the poor in Guatemala with this state of the art new technology.
They will present the path and the challenges for a successful clinical implementation, adequate staff preparation, training during the pandemic, comparison of treatment steps, modalities and results, considering the previous technology (CO-60) and the new machine efficiency. English and Spanish simultaneous translation will be available.
We recently spoke with Dr. Ruiz about this crucial treatment and new technology.
Why is it important to attend this webinar?
Cancer treatment with radiotherapy in Guatemala has traditionally been a privilege for a segment of the population that suffers from some cancer pathology. In this webinar, the audience will note that with interest and a change in attitude, it was possible that Guatemala (in a very short time) changed the way we offer radiotherapy from 1980 technology using 2D techniques and cobalt 60 treatments, to giving patients the opportunity to receive treatments standardized in centers worldwide, (IMRT and VMAT volumetric). This Halcyon technology from Varian was donated with the help of a grant from USAID and support from Washington University in St. Louis.
Today, Guatemala has an alternative to access high quality treatment and a higher cure rate when using radiotherapy with IMRT or VMAT.
What are the major differences between the previous technology and the new technology, for your clinic’s patients?
The process of a radiotherapy treatment involves several parts, in each of them it was possible to improve with new technology.
Previously, 2D simulation was used, that is, it was based on radiographs without taking into account the dose distribution, so that all tissues within the radiation field received the same dose, whether they were at-risk organ tissues or target tissues to be irradiated. With the new equipment, a computed tomography is used to mark the target tissue to be irradiated, reducing the radiation doses in the tissues of organs at risk. IMRT or VMAT radiotherapy reduces side effects and increases the dose where desired.
Formerly, treatment was delivered in irradiation machines based on cobalt 60, the dose was not well circumscribed to the desired tissue, and side effects were increased. Also treatment time took much longer. With the new Halcyon accelerator from Varian, treatments are much faster, better planned and circumscribed to exact areas, drastically reducing side effects and increasing the chances of cure. In other words, with the arrival of new technology, a quantum leap has been made in the treatment of cancer in Guatemala.
What is the percentage of patients in Guatemala who have been diagnosed with cancer? What is the percentage of those who are unable to pay for treatment?
There are no updated statistics, however the end of 2018 indicates that, within a population of more than 16 million, there is an estimated 15 thousand+ new cases of cancer annually. Our clinic receives patients from all over the country — about 2,100 new cases annually. There are three more private centers in the country, but all are in the capital city, which means patients have to travel for hours to receive treatment. Each center cares for a high volume of patients and there will always be a high volume of patients who are probably only operated on, but who do not receive the indicated treatment or who do not receive any type of treatment for their cancer.
In Guatemala, we are a population of approximately 17 million, of which 50.3% of the population lives in poverty or extreme poverty. Cancer treatment with radiotherapy is often inaccessible for them in one of the existing private centers so that 50% of new patients annually must be treated by the National League Against Cancer, which, with great financial effort, offers an alternative treatment with radiotherapy at very affordable prices.
With the arrival of new technology, thanks to the efforts of USAID and Washington University in St. Louis, the National League Against Cancer can offer a large Guatemalan population affected by cancer and in need of radiotherapy, access to better service, a longer life expectancy and better quality of life.
In what stage are these patients when they come to your clinic for treatment? Do you turn away patients?
In the latest statistics from 2018 from the National League Against Cancer and the clinic, the majority of patients who are treated present in more advanced stages, being more frequent in stages II, III, and IV. We see very few patients in the early stages of cancer.
How do you improve the quality of patient care while increasing the numbers of patients receiving care?
By having the technology to deliver treatment, we make sure that we have all the necessary implements, such as adequate immobilizers that were not previously available and with which we can now ensure better placement and better delivery of treatments.
We have been fortunate for the support received through USAID and Washington University. We have been given access to greater treatment technology and now have strengthened treatment capacities. We are grateful on behalf of our population for this support, and we respectfully request continued support to achieve a higher level of performance in the treatment of cancer in its various modalities. This will result in a greater impact on the Guatemalan society affected by cancer.
What are some of the next steps in this project? How can our readers help?
The next step would be to increase coverage with high-tech treatments to all patients, reducing treatment costs. Ideally, all patients could have free access. Currently the government, through the Ministry of Public Health and Social Assistance, subsidizes some patients each month, but not all, so there are some patients waiting, who are currently without treatment.
Another goal is to acquire additional technologies, such as SRS and SRBT radiosurgery, which are not yet available to our clinic. Additionally we are considering the following important goals:
- Implement an electronic record system throughout the hospital, in order to have better access to information for decision-making both in the area of patient care and treatment, as well as in the administration of our resources.
- Increase the response capacity of treatment to our cancer patients through the acquisition of a new accelerator with IMRT, VMAT, SRS and electrons capability.
- Have access to a QA treatment verification system for IMRT or VIMAT.
- Training for additional radiation therapists and physicists in modern radiation therapy techniques currently found in the U.S.
- Acquire nuclear magnetic resonance machines to strengthen our capabilities for early detection and planning of certain cancer pathologies.
The Cobalt-60-to-Halcyon Replacement in Guatemala – Session I
Tuesday, March 23 | 4 to 5 p.m. CST