Table 2.

Existing challenges for the effective implementation of treatment for cervical cancer and potential solutions

	Challenges	Opportunities for collaboration
Deficient external radiation resources	• No access to external radiation for treatment of locally advanced cervical cancer. • Deficient external radiation resources in reference to cervical cancer incidence. • Shortfall of radiation oncologists, medical physicists, therapists	• Increase awareness of role of radiation therapy in the treatment of cancer at the global level. • Prepare national/regional need statements (infrastructure and staff) for common cancers, including cervical cancer, for submission to national ministry. Include source replacement and maintenance costs. • Professional radiotherapy national or regional organisations to have sessions on ‘access to cervical cancer treatment and focus on health implementation’. • Public–private co-operation or inter-government donations of equipment. • Negotiate subsidised pricing of equipment at the global level. • Potential research on resource-sparing strategies for radiation treatment.
Access to optimal chemotherapy	• Drug stock outs. • Shortfall of trained staff for drug administration. • Delayed approvals for making drugs available to patients under subsidy schemes. • Poor compliance to chemotherapy. • Coexistence of HIV infection.	• Global advocacy for provision of essential medicines for cancer across countries. • Project needs for chemotherapy staff as part of resource planning for cervical cancer. • FastTrack subsidised medicines as part of a cervical cancer treatment package. • Global collaborations for staff sharing and training. • Test available digital technology to improve chemotherapy compliance and toxicity reporting in HICs and LMICs/LICs. • Collaborate to report outcomes for use and outcomes of chemotherapy within a framework of resource-stratified guidelines. • Improving patient compliance to highly active antiretroviral therapy and concurrent chemotherapy.
Access to brachytherapy	• Lack of adequate brachytherapy units in the LMICs. • Falling trend of brachytherapy use in developed countries. • Adequate training. • Lack of CT/MRI scanners in LMICs/LICs.	• Develop a global taskforce for brachytherapy mapping. • Develop financial and costing models in different case scenarios, including cost of applicators, source replacements and additional staff. • Develop ‘interinstitutional brachytherapy facility sharing models’ for testing feasibility and financial sustainability. • Global curriculum in brachytherapy for gynaecological cancers, including proficiency evaluation indices. • Global ‘reverse’ fellowships for brachytherapy and training courses. • Test low-cost image-based brachytherapy (ultrasound and CT). • Advocacy to improve access to imaging scanners in LICs and LMICs. • Systematic transition from two- to three-dimensional brachytherapy.
Access to palliative care	• Lack of studies in optimal palliative radiation. • Access to opioids.	• Prospective trials for testing palliative radiation regimens. • Global advocacy for improving opioid access in LMICs/LICs.
Barriers to research	Low number of cervical cancer studies. • Lack of collaborative groups within LMICs. • Lack of molecular driven therapeutics research. • Dearth of industry funding of cervical cancer research.	Expand existing collaborative groups to include centres in LICs and LMICs. • Develop cervical cancer treatment and research networks within LICs and LMICs. • Global health programmes can be used for health implementation or services research. • Educate industry on global call for elimination of cervical cancer and need for philanthropic funding of research. • Develop East–West collaborations for fostering molecular research. • Drug repositioning studies.

CT, computed tomography; HIC, high income country; LIC, low income country; LMIC, low–middle income country; MRI, magnetic resonance imaging.