Browsing by Author "Malhotra, S"

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    Publication
    Exploring the Cost of Radiation Therapy Delivery for Locally Advanced Cervical Cancer in a Public and a Private Center in Latin America Using Time-Driven Activity-Based Costing
    (Elsevier Inc., 2023) Li, B; Hirata, E; Trejo, JM; Garcia, B; Chang, B; Malhotra, S; Ning, M; Sarria, GJ
    In low- and middle-income countries (LMICs), 85% of cervical cancer diagnoses and 88% of cervical cancer deaths occur annually.1,2 The majority of presentations (with reports up to 75%)3 are locally advanced (International Federation of Gynecology and Obstetrics stages IB2 and IIBIVA) where combination external beam radiation therapy (EBRT) followed by brachytherapy is indicated for curative treatment.4 Despite large bodies of evidence that radiation therapy (RT) is effective for treating cancer, a shortage of economic investment limits its availability and contributes to global shortages.5,6 RT is generally described as a costeffective treatment, but only limited data exists about the institutional cost of combination RT in LMICs.7 Understanding treatment costs is critical for cancer capacity planning efforts, particularly in regions where radiation oncology is less understood or newly developing.
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    Publication
    Longitudinal Remote SBRT/SRS Training in Latin America: A Prospective Cohort Study
    (Frontiers Media S.A., 2022) Sarria, GR; Timmerman, R; Hermansen, M; Malhotra, S; Chang, B; Carter, R; Martinez, DA; Sarria, GJ; Giordano, FA; Chetty, IJ; Roa, D; Li, B
    Background: Continuing medical education in stereotactic technology are scarcely accessible in developing countries. We report the results of upscaling a longitudinal telehealth training course on stereotactic body radiation therapy (SBRT) and stereotactic radiosurgery (SRS), after successfully developing a pilot course in Latin America. Methods: Longitudinal training on SBRT and SRS was provided to radiation oncology practitioners in Peru and Colombia at no cost. The program included sixteen weekly 1-hour live conferencing sessions with interactive didactics and a cloud-based platform for case-based learning. Participant-reported confidence was measured in 16 SBRT/SRS practical domains, based on a 1-to-5 Likert scale. Pre- and post-curriculum exams were required for participation credit. Knowledge-baseline, pre- and post-curriculum surveys, overall and single professional-group confidence changes, and exam results were assessed. Results: One hundred and seventy-three radiotherapy professionals participated. An average of 56 (SD ±18) attendees per session were registered. Fifty (29.7%) participants completed the pre- and post-curriculum surveys, of which 30% were radiation oncologists (RO), 26% radiation therapists (RTT), 20% residents, 18% medical physicists and 6% neurosurgeons. Significant improvements were found across all 16 domains with overall mean +0.55 (SD ±0.17, p<0.001) Likert-scale points. Significant improvements in individual competences were most common among medical physicists, RTT and residents. Pre- and post-curriculum exams yielded a mean 16.15/30 (53.8 ± 20.3%) and 23.6/30 (78.7 ± 19.3%) correct answers (p<0.001). Conclusion: Longitudinal telehealth training is an effective method for improving confidence and knowledge on SBRT/SRS amongst professionals. Remote continuing medical education should be widely adopted in lower-middle income countries.