Table 2.

“Five S” framework for improving global palliative radiotherapy access

Dimension	Definition	Key interventions
Synergies	Collaborations between palliative RT and other movements	Integration with efforts in global palliative care, global HIV care, and universal health coverage
Staffing	Cadre of trained personnel, including radiation/clinical oncologists, nurses, radiotherapist, medical physicists	Expansion of human resources for health training models Revision of payment and incentive schemes for public sector staff
Stuff	Commodities of radiotherapy including megavoltage machines, simulation machines (e.g., CT), and planning and verification system	Selection of optimal machines for case load and environment Consideration of nuclear safety, political stability, and legal framework for transport when selecting radioactive sources
Space	Construction needed for RT including bunker and other physical infrastructure	Dissemination of adaptable facility plans with standardized dimensions and materials Inclusion of plans for patient housing in facility design Non-hierarchical networks of existing centers to standardize reduce inequity in treatment
Systems	Connections between RT and other levels of the healthcare system, including bilateral referral systems to and from RT	Focus on health IT systems and medical records for patient tracking Implementation of central and satellite models to distribute care evenly for palliative RT Telehealth interventions for virtual patient triage and preliminary evaluation

RT, radiotherapy; CT, computed tomography.