Pioneering progress amid resource constraints in African radiology and oncology

Experts are concerned about resource limits and insufficient radiology skills and services in Africa, particularly for cancer detection and treatment. As the continent grapples with the rising burden of cancer, the intersection of oncology and radiology emerges as a complex landscape where cutting-edge advancements contend with pressing issues of accessibility, affordability, and healthcare system economics.

Dr. Paul Rischbieter is a medical authority specialising in healthcare, diagnostic, and interventional radiology. Rischbieter is the chairperson for Africa Health Congress’ upcoming Radiology and Imaging conference, where he and other radiology experts will engage in an in-depth exploration of the most critical topics in the field. The conference is scheduled for Cape Town in October.

The event is formatted around dynamic sessions that encourage meaningful knowledge exchange and actionable insights. Field-leading experts from around the continent will zoom in on topics like screening and diagnosis for breast, prostate and other forms of cancer, and unpack advancements in emerging tech like CT scans, MRI and AI-powered diagnostics.

Elaborating on the state of his field, Rischbieter says that oncology has seen steady advances in recent years, improving lifespans and healthcare outcomes.

"The rate and quality of detection has improved, resulting in fewer missed and late diagnoses. This allows us to treat cancers earlier, with less damage and fewer complications. There are also highly sophisticated, effective drugs that have recently come on to the market."

Simultaneously, advancements in immunotherapy and minimally invasive surgical treatment options have expanded the oncologist's toolkit.

However, these improvements have brought new challenges to the forefront, he explains.

Earlier interventions result in a better quality of life for patients. However, from a broader health systems perspective, these successes paradoxically result in mounting costs. As people live longer and survive what were previously considered terminal diagnoses, they inadvertently place a greater burden on national health systems with increased illness and old-age care needs.

Most African states, South Africa included, have a dual funding model: public and private, he adds.

"In private settings, many countries offer small boutique high-end services in oncology, for both treatment and diagnostics, often provided by internationally trained doctors. In South Africa, there’s very little that isn’t available, within the private sphere."

"SA and other African countries have kept pace with global progress. Around 80% of cancer detection and diagnosis technologies is available in most African countries (apart from immunotherapy). However, these options are so expensive that they end up primarily benefiting only foreign nationals, expats and very wealthy local people, and fail to reach the broader population."

"Most countries have the technology, albeit on a much smaller scale than what's needed to service the entire population, and services are skewered towards the wealthy, who can pay cash, or who have international medical insurance," he continues.

"Cancer detection and treatment is unfortunately very expensive. Oncology drugs can cost up to R735 000 per dose, over the course of 10 – 15 doses. For example, one specific drug treatment that is new on the market costs R500 000 per month"

Rischbieter explains that the latest drug-based treatments are prohibitively expensive globally, not just in Africa.

"The most cutting-edge technologies and drugs in oncology are usually only available to the wealthiest people in places like America, England and Europe, too. Insurers there also insist on patients paying cash up front."

The problem is that in Africa, the costs for even established, mainstay treatments and procedures are more than what most people can afford, he says.

Emerging technologies, particularly artificial intelligence will also be on the conference agenda. These innovations are increasingly being integrated into radiological practices and workflows, augmenting the capabilities of medical professionals in cancer detection and potentially alleviating the strain on healthcare systems.

However, Dr. Rischbieter cautions that the integration of AI is proceeding more slowly than many anticipate. "New innovations have to be adopted slowly and carefully in medicine, ensuring accountability at every stage in the patient journey. We need to carefully verify that these inchoate innovations accrue the promised cost savings, result in streamlined workflows, and better healthcare outcomes."

All these multifaceted nuances will need to be kept in mind as SA continues to navigate the complexities of implementing the National Health Insurance, especially as it pertains to healthcare economics at the national scale in cost-intensive areas of medicine like oncology and radiology.

Against this backdrop, the upcoming Africa Health Congress aims to address these challenges and explore new opportunities.

The Imaging & Diagnostics Conference is one of the longest-running segments of the Africa Health Congress. It has become a seminal platform for African radiology. Taking place in Cape Town later this year, the event aims to serve as an industry convergence touchpoint and a platform for sharing knowledge around insights, trends, and technologies in cancer imaging and diagnostics.

"The conference serves as a networking and knowledge-sharing space and will offer value to medical leaders like radiography chiefs, directors and consultants, as well as the technicians, radiographers, sonographers, technologists, and radiology nurses working on the front lines of cancer treatment and screening," Dr. Rischbieter explains. "It's a platform for industry players and heads to map a path forward for oncological radiology in Africa."