Revolutionizing Cancer Treatment in Papua New Guinea: The Resurgence of Radiotherapy Services
After a long period of dormancy, the radiotherapy services in Papua New Guinea have been revitalized, bringing renewed hope to thousands of cancer patients across the nation. With substantial backing from the International Atomic Energy Agency (IAEA), the country’s sole radiotherapy machine resumed operations six months ago. This development marks a significant leap forward for cancer treatment in Papua New Guinea, a country that has struggled with limited healthcare resources for years.
This month, Angau Memorial Hospital, a pivotal healthcare institution located in Lae—the bustling shipping hub in the north of Papua New Guinea—has further enhanced its radiation medicine services with the introduction of brachytherapy. This essential procedure is particularly vital in the treatment of cervical cancer, a prevalent health issue in the region.
Athula Kumara, a medical physics expert at Angau Memorial Hospital, expressed the significance of this advancement: "This milestone represents a significant advancement in our cervical cancer treatment capabilities, offering more precise and localized therapy options to improve patient outcomes." The hospital, which serves as a regional referral center for approximately 1.9 million residents, is crucial in addressing the healthcare needs of the Morobe Province’s 675,000 people.
The Cancer Burden in Papua New Guinea
Cancer remains a daunting public health challenge in Papua New Guinea. According to figures from the International Agency for Research on Cancer (IARC) in 2022, the country witnesses over 12,000 new cancer cases and more than 7,000 cancer-related deaths each year. Among women, breast cancer, cervical cancer, and lip and oral cancers are the most common types.
Understanding Brachytherapy
Brachytherapy is a form of internal radiotherapy where sealed radioactive sources are strategically placed inside or near a tumor. This method allows for high doses of radiation to be delivered directly to the cancerous cells while minimizing damage to surrounding healthy tissues. This procedure is a critical component of radiation treatment for gynecological cancers such as cervical cancer. Additionally, it can be employed to treat prostate, breast, soft tissue sarcomas, certain head and neck tumors, and skin cancers.
The brachytherapy equipment was installed at Angau Memorial Hospital in late 2024, and its services commenced this month. The first patient to benefit from this procedure was a woman diagnosed with cervical cancer. Having undergone external beam radiotherapy the previous year, she is now receiving brachytherapy to enhance her treatment.
The Journey to Reestablish Radiotherapy Services
The path to reestablishing radiotherapy services at Angau Memorial Hospital was fraught with challenges. Services had been discontinued in 2016, severely limiting treatment options for cancer patients within the country. Many patients faced the daunting prospect of seeking treatment abroad, an option that was not feasible for most due to the prohibitive costs. As Kumara noted, "Some travelled to Manila for treatment, but these cases were rare due to the high cost of travel and treatment."
In 2023, an imPACT review, conducted by the IAEA in collaboration with the World Health Organization (WHO) and the International Agency for Research on Cancer (IARC), underscored the urgent need to reestablish radiotherapy services in Papua New Guinea. Through its technical cooperation and human health programs, the IAEA played a pivotal role in supporting Angau Memorial Hospital. They facilitated the replacement of the radiotherapy machine’s radioactive source and provided guidance on acquiring the new brachytherapy unit. Radiotherapy services resumed in mid-August 2024, and since then, Angau has been treating an average of 50 patients per month, with hundreds more registered for treatment. Kumara proudly stated, "Treatment has been very successful, and we have seen many patients recover significantly after undergoing therapy."
Building Capacity Through Training
A crucial prerequisite for enhancing radiation medicine capabilities has been training medical physicists. These highly specialized health professionals ensure that equipment performs optimally and that treatment procedures are both high-quality and safe. Daniel Berger, a medical physicist in the IAEA’s Division of Human Health, has been instrumental in leading recent technical missions to build local capacity in Papua New Guinea. He explained, "Their expertise enables precise dosimetry, planning, and dose delivery while ensuring equipment and clinical processes meet international standards for effective patient care."
Medical physicists also play a vital role in providing technical guidance for infrastructure improvements. They collaborate closely with regulatory authorities to license and deploy nuclear and radiation medicine equipment. Berger emphasized the importance of their work, stating, "Their work ensures that radiotherapy services can meet the growing demand for cancer care, ultimately helping to improve patient outcomes and advance healthcare standards."
The Role of Radiotherapy in Cancer Treatment
Radiotherapy is one of the main pillars of cancer treatment, alongside surgery and chemotherapy. Recognizing the critical need for accessible cancer treatment, the IAEA launched the Rays of Hope initiative in 2022. This initiative aims to support countries in increasing access to life-saving radiotherapy treatment. Since becoming a Member State in 2012, Papua New Guinea has received substantial support from the IAEA to strengthen radiation safety and expand its capacity for cancer diagnosis and treatment.
The Challenges of Early Diagnosis
Despite the progress made in advancing cancer care in Papua New Guinea, challenges remain, particularly in the areas of early diagnosis and treatment provision. Kumara highlighted a significant issue: "Patients arrive at very late stages of their cancer, often with extensive masses. By the time they seek treatment, the cancer has already spread, making it more difficult to achieve optimal outcomes." He emphasized the need to increase awareness, especially in remote areas where access to healthcare is limited.
A Global Perspective on Cervical Cancer
Cervical cancer is the fourth most common cancer in women worldwide, with approximately 660,000 new cases in 2022. The disease is responsible for about 350,000 deaths annually, with a staggering 94% of these deaths occurring in low- and middle-income countries. This disparity is largely driven by inequalities in access to vaccination against the human papillomavirus (HPV), which is responsible for 95% of all cervical cancers, as well as screening and treatment services.
January is recognized as Cervical Cancer Awareness Month in many countries, serving as a platform to promote HPV vaccination for prevention and early diagnosis and treatment of pre-cancers. These efforts significantly improve the prospects for a cure and highlight the importance of addressing cervical cancer at an early stage.
In conclusion, the revival of radiotherapy services in Papua New Guinea represents a significant step forward in the fight against cancer. With continued support from international organizations like the IAEA, the country is making strides in enhancing cancer treatment capabilities and improving patient outcomes. However, challenges remain, particularly in reaching underserved populations and promoting early diagnosis and treatment. As the country moves forward, a continued focus on awareness and access to healthcare will be essential in combating cancer and improving the lives of those affected by the disease.
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