Global Patient Education for Radiation Therapy in Low- and Middle-Income Countries: Where Do We Stand?

Summary: Despite the critical role of radiation oncology in cancer treatment, patient education for radiation therapy (RT) remains significantly understudied, especially in low- and middle-income countries (LMICs). The lack of data not only hinders the improvement of patient care but also reflects broader disparities in global health resources and knowledge distribution. This systematic review aims to assess the current state of research on patient education within the field of radiation oncology in LMICs. This review was conducted following PRISMA guidelines. We systematically searched databases including PubMed, Cochrane Library, and Embase for studies published up to January 2024, using terms related to “radiation oncology” or “radiation therapy” or “radiotherapy” and “patient education”. We classified LMICs based on the World Bank’s current classification of (LMICs) – low-income, lower-middle, upper-middle income countries. Inclusion criteria identified studies focusing on patient education programs within radiation oncology settings in LMICs. The primary outcome was the availability of data on the efficacy, design, and implementation of patient education strategies in these settings. The initial search yielded 16,872 articles, of which a total of 4,955 full-text articles met pre-screening criteria for relevance and quality. None of the full-text articles met the inclusion criteria. Most excluded studies were not focused on LMICs (97%). If studies were in LMICs (3%), they did not specifically address RT and were unrelated to patient education for treatment options, rationale, and side effects. No studies were available to evaluate the effectiveness, content, or delivery methods of patient education in these regions. This empty systematic review on patient education for RT in LMICs highlights a critical gap in research that requires urgent attention. The lack of evidence stresses the disparities in cancer care and education between high-income countries and LMICs. Further work is necessary to study existing patient education practices, pinpointing existing barriers or deficiencies, and establish patient education initiatives to specifically address the unique challenges faced by RT centers in LMICs. Bridging this gap presents a significant opportunity for improving patient engagement, satisfaction, and outcomes in cancer care globally, thus democratizing the benefits of advancements in radiation oncology on a global scale. Rohan K. Patel (he/him/his), MD (Presenting Author) - Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University; Benjamin Li (he/him/his), MD, MBA (Co-Author) - Department of Radiation Oncology, University of Washington; Rayos Contra Cancer