Sir - We read with interest the paper by Jeremic and colleagues [1] regarding access to radiotherapy in Africa. Of the 15 surveyed institutions, only one seems to employ 'clinical oncologists', with the remainder having 'radiation oncologists'. Manpower shortages in low and middle income counties have resulted in inequities in health care access, long waiting times for diagnosis and treatment, and subsequent elevated health care costs for patients [2,3]. In these countries the disease burden, with increased rates of cervix and oesophageal cancers for example, is more heavily weighted towards those malignancies that can be managed with radiotherapy or chemoradiotherapy [4]. Having a single practitioner who can deliver systemic treatments in addition to radiotherapy would therefore seem to be advantageous. We would advocate encouraging a dual training approach that would reduce the number of clinicians an individual patient needs to see and allow a more flexible workforce. It would potentially assist in addressing the severe manpower issues many low and middle income countries face.
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