Radiation oncology is a specialty defined as much by its challenges as by its technology. Across continents, radiation oncologists describe working at the intersection of life-saving innovation and persistent systemic obstacles — limited resources, workforce shortages, administrative burden, unequal access to care, and the emotional weight of treating patients with serious illness. While the machines grow more sophisticated, many clinicians feel the human and structural support around them has not kept pace.
In high-income countries, frustrations often center on time pressure, documentation overload, and the struggle to maintain meaningful patient relationships in increasingly efficiency-driven systems. In low- and middle-income settings, the challenges are more fundamental: too few machines, delayed diagnoses, long waiting lists, and patients traveling vast distances for treatment. Across all regions, physicians speak about burnout, moral distress when optimal care is not possible, and the responsibility of making high-stakes decisions daily.
This articelis about the people who stand at that intersection every day, translating physics into care and technology into trust.
Disclaimer: The insights and comments presented in this article were collected over the last three months from radiation oncologists across various continents. While every effort has been made to capture the most current perspectives, some information may be subject to change as the field of radiation oncology evolves. The challenges and issues highlighted may reflect the realities at the time of collection but could differ based on new advancements, clinical practices, or emerging data.
Radiation Oncology in Australia Faces Workforce Crisis, Proffesional Says
In interview, Sandra Turner, a leading radiation oncologist and Clinical Professor at The University of Sydney, has highlighted the pressing challenges facing Australia’s radiation oncology workforce. While Australia’s healthcare system is widely praised for its wealth and access to cancer services, Turner pointed out a critical issue: the shortage of radiation therapists (RTs).
“We are very fortunate in Australia to live in a wealthy country with access to excellent cancer care, including radiotherapy,”
Prof. Turner explained.
“However, in recent years, we’ve seen a significant issue emerge — the shortage of radiation therapists. This shortage affects not only the timely delivery of treatment but also the advancement of research and clinical developments in our field.”
Prof. Turner, who also serves as the Clinical Lead for the WSLHD FLASH leadership programs, emphasized that the situation is particularly dire in New South Wales, where the universities are training far too few radiation therapists each year.
“In my large state of New South Wales, universities are only training a very small number of radiation therapists annually. We’ve had to rely heavily on recruiting staff from overseas, particularly from countries like Ireland, which is also facing its own shortages.”
This growing workforce gap has placed immense pressure on the existing radiation therapists, Turner noted.
“The existing staff are under a lot of pressure. Career progression and remuneration haven’t kept pace with other professions, or even conditions in other parts of Australia. As a result, many RTs are leaving for private centers, relocating to other cities, or even leaving the profession altogether.”
Despite these challenges, Turner praised the resilience of Australia’s radiation therapists.
“Despite the pressures, our dedicated radiation therapists continue to deliver high-quality radiotherapy. The care they provide for our patients is nothing short of excellent, but it’s becoming increasingly difficult to maintain that level of care under the current conditions,”
she remarked.
Prof. Turner’s reflections on Australia’s RT workforce were contrasted sharply during her recent visit to Tunisia for the AORTIC (African Organization for Research and Training in Cancer) conference.
“I had the privilege of meeting many inspiring radiation oncology professionals and cancer patients from across Africa. Of course, I was aware of the challenges they face, but hearing their stories firsthand was a life-changing experience.”
She described the severe shortages of radiotherapy equipment and trained professionals in many African countries, with some nations lacking even a single radiotherapy machine.
“It was heart-wrenching to hear the struggles these professionals face”
she shared.
“Many of the stories I heard were sobering, yet the dedication and passion for improving radiotherapy services in such a resource-poor setting was awe-inspiring.”
However, Turner also highlighted a key issue regarding the migration of trained professionals from Africa to wealthier countries. She explained that during her visit, she had met several radiation therapy educators who had trained skilled professionals in Africa, only to see them leave for countries with more resources, such as Australia and Ireland. While she acknowledged that the desire for better opportunities was understandable, she noted that this migration only worsened the shortage of qualified staff in Africa, leaving many countries unable to meet the growing demand for cancer care.
Prof. Turner emphasized that the “brain drain” was not a sustainable solution to the global inequities in cancer care. She pointed out that relying on this strategy was not viable, explaining that the solution should not involve pulling resources from one region to fill gaps in another. While she acknowledged that people had the right to seek better opportunities, Turner stressed that this approach would not address the underlying issues in global cancer care.
Reflecting on her experience at AORTIC, Turner stressed the importance of global collaboration and shared responsibility in tackling the challenges facing radiation oncology worldwide.
“The challenges we face in radiation oncology, whether in high-income or low-income countries, are often more similar than we realize. By sharing our experiences, supporting each other, and working together, we can improve awareness, education, and advocacy for better access to radiotherapy.”
As the global radiation oncology community continues to grapple with these issues, Turner is hopeful that progress can be made.
“We must all strive to improve access to radiotherapy, support our colleagues worldwide, and ensure that the patient remains at the heart of our work, no matter where they are”.
Radiation Oncology in Nepal: A Journey of Hope and Progress
In an exclusive interview, Dr. Vivek Ghosh, Consultant Clinical Oncologist at Birat Cancer Institute in Nepal, discussed the challenges and progress in the country’s radiation oncology field. He highlighted the emotional weight of treating patients with locally advanced or metastatic cancers, often after long delays in seeking care.
“Explaining how delayed presentation limits treatment potential is one of the toughest aspects of our practice”
he shared.
Geography, perception, and economics shape cancer care in Nepal. Many patients travel long distances to reach radiotherapy centers, and some still believe effective treatment is only available abroad, particularly in India. Dr. Ghosh noted that treatment in Nepal is often more affordable and easier to access, offering financial relief and sparing families from the emotional strain of traveling abroad.
Beyond treatment costs, families also face challenges with nutrition, transportation, and home care, compounded by low cancer literacy. However, Dr. Ghosh has seen a positive shift.
“Trust in Nepali cancer care has grown, especially among middle-class families.”
he explained. More patients are choosing local treatment, and many return to their communities with confidence, saying,
“Care in Nepal is not a compromise; it is a luxury that doesn’t sacrifice quality.”
Dr. Ghosh emphasized that cured patients have become powerful advocates for Nepali cancer care, reshaping societal beliefs and encouraging others to seek timely treatment. While rapid technological advances in radiation oncology bring challenges, patient safety remains the top priority.
“At Birat Cancer Institute, no patient is turned away due to financial hardship”
he affirmed.
Looking forward, Dr. Ghosh remains hopeful.
“Every survivor who advocates for Nepali care and each incremental improvement in access is contributing to a quiet but powerful transformation”
he said.
“Radiation oncology may rely on technology, but its true strength lies in the humanity and trust between patients and professionals.”
Radiation Oncology in Western Europe: Administrative Burden and Emotional Strain
In an anonymous contribution, a radiation oncologist from Western Europe shared their insights into the ongoing challenges faced in the field. According to the expert, the day-to-day work in radiation oncology involves a delicate balance between technical precision and human empathy.
One of the most significant challenges radiation oncologists face is balancing the technical demands of their work with the emotional needs of their patients.
“On one hand, we must ensure technical precision—calculating doses, aligning machines, and verifying treatment plans with millimeter accuracy”
they explained.
“On the other, we are caring for patients who are often frightened, in pain, or emotionally overwhelmed. The challenge is to maintain both technical rigor and human connection, even when time is limited.”
The expert also highlighted the growing administrative burden within the field. Increasing documentation and compliance requirements are consuming more of their time, leading to frustration and burnout.
“We spend more time on paperwork—signing lab reports for clinical trials or managing financial pressures—than on direct patient care,”
they said.
“This imbalance can lead to significant stress and fatigue.”
Radiation Oncology in the Canary Islands: Overcoming Geographic Challenges to Deliver High-Quality Care
The work of a radiation oncologist in the Canary Islands presents unique challenges due to the region’s geographic dispersion, as explained by Dr. Barbara Salas Salas, a Radiation Oncologist at Hospital Universitario de Gran Canaria Dr. Negrín. For many years, patients requiring radiotherapy had to travel to the main island of Gran Canaria, a journey that created significant difficulties not only for the patients but also for their families. However, over the past four years, a dedicated effort has been made to transform this service by establishing satellite radiotherapy units across the islands.
“We’ve worked diligently to ensure patients no longer have to leave their communities,”
said Dr. Salas.
“Through collaboration with nursing teams and radiation therapy technicians, we’ve managed to bring radiotherapy closer to home, allowing us to travel to the smaller islands to provide treatment.”
Despite these advancements, challenges remain. The constant travel between islands has placed a considerable strain on both the healthcare professionals and the system itself.
“The pressure is high, as we must maintain a high level of vigilance while staying up-to-date with new advancements. The daily workload can be exhausting, and balancing this with personal life is a constant challenge,”
Dr. Salas acknowledged.
The success of this model has been possible thanks to the support of the department heads and the commitment of multidisciplinary teams working on every island.
“The unconditional support of our service chief, alongside the efforts of our teams on each island, has been crucial in making this model a reality, providing high-quality and accessible care for our patients,”
Dr. Salas explained.
Looking ahead, Dr. Salas emphasized the importance of continued improvement in the region’s radiation oncology services.
“What would truly help is having more highly specialized staff and optimizing task distribution so we can continue providing quality care without compromising patient safety or our mental health.”
While the demands of the job are great, the sense of fulfillment that comes from improving patients’ lives is a reward that makes the sacrifice worthwhile.
“Although the personal and professional sacrifice is significant, the satisfaction of contributing to the lives of our patients and seeing positive results is what keeps us motivated to keep going,”
Dr. Salas concluded.
Radiation Oncology in Latin America: Resource Gaps and Access Challenges
In an exclusive interview, Dr. Claudia Carvajal, Radiation Oncologist and Past President of the Chilean Radiation Oncology Society, discussed the significant challenges faced by radiation oncologists in Latin America.
“The easy part of our job is taking care of patients we already know,”
she explained.
“But the hard part is truly having the chance to care for all patients who need radiation in their cancer treatment across our countries.”
Dr. Carvajal pointed out that many centers in Latin America struggle with long waiting lists for radiation therapy, which compromises the quality and safety of care.
“As a region, we are short of both human and physical resources to meet the needs of our cancer population,”
she stated. This shortage is further exacerbated by the high cost of new technologies, which, while offering potential solutions, are often out of reach.
“Many of these technologies are simply too expensive for us,”
she added.
Another key challenge Dr. Carvajal highlighted is the lack of trained medical physicists.
“Medical physicists, who are crucial to the safety of our treatments, face significant difficulties in obtaining the training they need,”
she noted.
“It would be immensely beneficial if more educational resources were available to help overcome these barriers.”
In addition, Dr. Carvajal emphasized the need for better financial support to develop the necessary resources for radiation oncology.
“Our treatment is cost-effective, yet political decisions often favor expensive alternative therapies over radiation therapy,”
she explained.
“A financial system that supports the creation and maintenance of human and physical resources is critical for ensuring equitable access to care.”
Radiation Oncology in Africa: Navigating Challenges in Access and Care
“Radiation oncology is a critical field where precision meets compassion,”
Hannatu Ayuba a Consultant Radiation and Clinical Oncologist at the National Hospital Abuja, CEO of the Cancer Consciousness Initiative, and Program Lead for the TeleOncology Hub. She shares a poignant memory from three weeks ago when a bolt driver, who had received surgery and radiotherapy at the hospital in 2019, approached him.
“That was a gold medal moment for me,”
she admits.
“In a context like ours in Low and Middle-Income Countries (LMICs), where cancer disparities are stark, especially with advanced disease stage presentations and high morbidity, it feels like a true victory.”
The oncologist speaks to the ongoing challenges in Nigeria, particularly with unequal access to radiotherapy in rural areas.
“How accessible is radiotherapy to the average person in rural areas?”
she asks.
The issue of access to care remains a critical problem, with technological advancements often outpacing the necessary infrastructure in many regions. In Nigeria, patients are forced to travel long distances to access radiotherapy.
“Patients have to travel far to access specialist cancer care and radiotherapy,”
she explains, adding that this results in significant inconvenience, disrupts family dynamics, and places a heavy strain on both the patients and their caregivers.
Healthcare worker shortages, advanced disease presentations, and the overwhelming patient loads are challenges that push healthcare professionals to their limits.
“These pressures risk burnout, and ensuring patient safety amidst complex treatments is a constant challenge,”
she acknowledges. He stresses that regular capacity-building initiatives are essential to cope with the growing demands of cancer care.
Despite these obstacles, the oncologist remains hopeful.
“Rapid advancements in technology bring promise but also pressure to adapt quickly,”
she explains.
“The human side of radiation oncology lies in balancing technological precision with empathetic patient care. It’s a field where small errors can have big consequences, making continuous knowledge updates and teamwork crucial.”
Even with the significant challenges, the oncologist is deeply motivated by the impact of his work.
“Seeing patients heal, receiving patient-centered care that addresses the individual holistically, and improving their quality of life makes it all worthwhile,”
she concludes.
Radiation Oncology in North America: Disparities Between Canada and the USA
Dr. Layth Mula-Hussain, a Radiation Oncologist at the Cape Breton Cancer Center and Assistant Professor at Dalhousie University in Nova Scotia, Canada, discussed the significant disparities in cancer care between North American countries, particularly between Canada and the United States. He emphasized that despite being geographically close, there are notable differences in healthcare access. Canada’s public healthcare system provides broader access to radiotherapy, reducing financial barriers for patients. However, the system faces its own challenges, such as workforce shortages and long waiting times in certain regions.
One of the critical gaps in Canada, as pointed out by Dr. Mula-Hussain, is the absence of proton therapy. Unlike the U.S., where proton therapy is available in several centers, Canada currently does not have a proton therapy facility, which limits treatment options for certain patients, especially those with specific types of cancer that could benefit from this advanced technology.
In the United States, while the private healthcare system offers access to advanced technologies, including proton therapy, it also creates a significant disparity in access based on insurance coverage. For many U.S. patients, the cost of radiation therapy is largely determined by their insurance, making it difficult for those without sufficient coverage to access necessary treatments.
Dr. Mula-Hussain also addressed the geographical challenges that impact cancer care in both countries. Canada’s vast size, with its geographically dispersed population, creates travel barriers for patients needing radiotherapy. Many patients must travel long distances to receive treatment, which is especially difficult in rural and remote areas. Although patients are often funded for travel and treatment, the logistics still place significant strain on patients and their families.
Outline
Radiation oncology professionals worldwide are navigating a range of challenges that vary by region but share common threads. In Latin America, healthcare disparities persist, with significant barriers to access, including long waiting lists, under-resourced centers, and insufficient staff. Despite these hurdles, collaboration between scientific societies and ongoing efforts to expand radiotherapy access—such as satellite treatment units—are driving positive change. However, the high cost of technology and training shortages for key personnel, like medical physicists, remain pressing concerns.
In Western Europe, radiation oncologists face the difficult task of balancing technical precision with the emotional needs of patients, all while dealing with administrative burdens and workforce shortages. The pressure of adapting to rapid technological advancements, like AI and proton therapy, exacerbates the situation. Mental health support, better staffing ratios, and more streamlined workflows are essential to maintaining quality patient care without overwhelming healthcare professionals.
Meanwhile, in Africa, radiation oncology is deeply affected by limited infrastructure, high patient volumes, and a lack of trained personnel. Advances in technology offer hope, but the financial strain on healthcare systems hampers widespread adoption. The emphasis on holistic, patient-centered care remains crucial, even as the industry works to expand access to care and build stronger, more resilient healthcare teams.
In Nigeria, the disparities in cancer care are stark. Patients often face long journeys to access radiotherapy, and the scarcity of skilled professionals and resources continues to affect treatment quality. However, radiation oncology experts are working tirelessly to address these disparities by developing new systems and improving accessibility, while also advocating for more government support and training initiatives.
Lastly, in the Canary Islands, geographic challenges create unique obstacles for radiation oncologists, who have worked hard to establish satellite radiotherapy units to bring treatment closer to patients. Despite the strain caused by constant travel between islands and the need for continuous learning to stay up-to-date with new technologies, the dedicated healthcare teams continue to make significant strides in providing high-quality, accessible cancer care.
Across all regions, the common thread is the passion and dedication of radiation oncologists and healthcare teams who continue to provide the best possible care despite overwhelming challenges. Ensuring access to care, investing in staff well-being, and continuing to innovate and collaborate are essential steps in addressing global disparities in cancer treatment.
Written By Aren Karapetyan, MD