Year 2016 has been a significant year for cancer treatment in Nepal. Nepal Cancer Hospital and research center (NCHRC) in Lalitpur will soon start radiotherapy services with Varian Truebeam machine while Kathmandu Cancer Care and Research Center (KCCRC) in Bhaktapur has already started radiotherapy services with Elekta Synergy machine recently. Both of these machines are modern medical linear accelerators from two different companies. Previously, only BPKCH in Bharatpur and Manipal hospital in Pokhara had medical LINACS. NCHRC is also going to start High Dose Rate Brachytherapy with 24 Channel Gammamed ix plus machines to treat gynecological malignancies. With the addition of these two new external beam radiotherapy machines in Nepalese Health Care system and one HDR Brachytherapy machines, we are now capable of performing modern cancer treatment techniques like 3DCRT, IMRT, VMAT/Rapid Arc, Stereotatic Radiosurgery & Stereotatic Body Radiotherapy,Total Body Irradiation in the country.
Previously, Cancer patients who had indication for such treatment techniques had to go abroad to receive such treatments. There used to be tremendous financial, psychological and practical difficulties for cancer patients and their families to receive such treatment in abroad. With these new medical facilities in the country, cancer patients and their near ones will surely be relieved with such pressures.
However, with the addition of new facilities in diagnostic radiology and radiation therapy, there is a rising challenges in the part of the service providers and government of Nepal to establish adequate radiation infrastructure for smooth functioning of such facilities in the country.
Firstly, since radiation therapy machine produces ionizing radiation to cure malignancies, proper handling of such equipment is important. There should be a quality assurance mechanism to ensure quality treatment with these machines. Proper treatment outcome of radiotherapy requires the joint effort of Radiation Oncologists, Medical Physicists, Radiation Technologist, Oncology Nurses and others involved. Nevertheless, Medical Physics, Radiation Technology and Oncology Nursing courses are not offered in the country. So there is a shortage of these professionals in the country. GoN should take actions to prepare such human resources in the country.
Secondly, radiation monitoring is an important aspect of radiation safety. But due to the lack of radiation law, radiation regulatory body and infrastructural arrangement, there is difficulty in adopting proper guidelines and dose audits. So it is important to draft radiation law, establish regulatory body and make infrastructural arrangement as soon as possible. Drafting radiation law and establishing radiation regulatory body with give basic guidelines in operating radiation facility and help to move further to prepare necessary documents to ensure quality treatment.
Thirdly, most radiotherapy machines and related equipments are specially designed highly advanced machine. Establishing radiotherapy facilities requires huge investment. So GoN should facilitate in all possible ways to encourage health service entrepreneurs and hence increase access to specialized health services for cancer patients within the country. This will ultimately appease cancer patients and their near ones by minimizing their financial burden, psychological pressure etc. In addition, millions of rupees is retained in the country which would otherwise be spent aboard to get the radiotherapy services there.
In conclusion, with the rise in number of radiation facilities, particularly megavoltage radiotherapy facility, there is an urgent need to prepare basic and additional infrastructures for quality radiotherapy services for cancer patients.
By Suresh Poudel, Medical Physicist, Nepal Cancer Hospital and Research Center, Harisiddhi, Lalitpur