Transforming radiotherapy care pathways in Sri Lanka

Radiotherapy researchers at Manchester are working with colleagues in Sri Lanka to increase access to affordable treatment and improve outcomes for patients with bladder cancer.

Global challenge: limited access to healthcare resources

More than 50% of cancer patients worldwide require radiotherapy as part of their treatment. For patients in developed countries, there is standardised access to radiotherapy. In Manchester, for example, The Christie NHS Foundation Trust delivers one in twenty NHS radiotherapy treatments in the UK.

Access to treatments such as these are far more limited across the rest of the world. Countries including Uganda and Kenya have one radiotherapy centre to serve the entire nation and the treatment remains an expensive, resource-intensive method.

More cost-effective treatments are required to help increase cancer survival rates in developing countries and reduce global health inequalities.

Manchester solution: a cost-effective alternative to chemotherapy

A pioneering clinical trial led by a Manchester research team showed that survival from bladder cancer could be increased by 13% using a cheap and simple alternative to chemotherapy.

If a bladder tumour outgrows its blood supply, parts of it can become deoxygenated (hypoxia). Hypoxic tumours can be more resistant to radiotherapy, so they are harder to treat. The challenge is making the tumour cells more sensitive (radiosensitisation).

The Manchester team explored bladder carbogen and nicotinamide combined with radiotherapy (BCON) as an innovative solution to treat the disease. In BCON treatment, a patient must take nicotinamide vitamin B tablets before radiotherapy and continuously breathe a high dose of oxygen (carbogen) during radiotherapy. This combination supplies the cancerous cells with oxygen and makes them more sensitive to radiotherapy. Research showed that BCON is a well-tolerated, low-cost and easily deliverable hypoxic radiosensitiser, highly suited as an alternative to chemotherapy in resource-limited settings.

Professor Ananya Choudhury, Chair and Honorary Consultant in Clinical Oncology, at The University of Manchester was one of the first consultants to accept and use this new treatment method, developed by her colleague Professor Peter Hoskin, Professor of Oncology.

“It’s [BCON] one more way of delivering radiosensitisation that does not involve invasive procedures, prolonged visits to hospital or systemic therapy expertise,” says Professor Choudhury.

Our aim is to provide the best treatment possible for all those in our society who require it within the limitations of their healthcare systems – this often involves simple solutions.

Professor Ananya Choudhury / Chair and Honorary Consultant in Clinical Oncology

Partnering to bring research benefits to the Sri Lankan population

The benefits of this alternative treatment were recognised by Dr Nuradh Joseph, a Clinical Training Fellow visiting Manchester from Sri Lanka. In partnership with University researchers, Dr Joseph learnt how to deliver the treatment and implement it upon his return to Sri Lanka. Since then, BCON has been accepted as an effective, low-cost and low-resource treatment method against bladder cancer.

Professor Choudhury explains: “In terms of health economics, BCON represents an ideal treatment option for low to middle-income countries; cost per treatment is only £200 compared to more expensive options like chemoradiotherapy. In countries with very few cancer centres, this can increase access to treatment as it can be used more widely in less specialised settings.”

Delivering the best possible treatment for all societies

The simple solution of taking breathing gas and tablets at the same time as radiotherapy demonstrates how innovative thinking can meet real-world needs and improve survivorship for people with bladder cancer in low middle-income countries.

“More than 50% of people in the world do not have access to basic radiotherapy treatment – changing this should be a priority,” states Professor Choudhury. “There are inexpensive ways of improving radiotherapy outcomes for patients, as we’ve shown with BCON. The challenge for us in high-resource settings is to adopt a more global perspective that is supported by industry and politicians."

“Our ultimate aim is to provide the best treatment possible for all those in our societies who require it within the limitations of their healthcare systems – this often involves simple solutions.”

Research impacts

The University of Manchester’s research has helped to:

  • adopt findings from the first clinical trial for bladder cancer and pioneer BCON as a treatment method;
  • change clinical practise for bladder cancer treatment in Sri Lanka and a number of other countries;
  • identify a low-cost, low-resource option for bladder cancer treatment in global nations;
  • establish a successful virtual oncology training and education programme, which supports students from Sri Lanka;
  • lead the global charge to show the economic and patient benefits of BCON treatment in low-resource nations;
  • establish a Clinical Fellows training programme between research leads in Manchester and Sri Lanka to share clinical practice and implementation learnings.

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