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
