World Cancer Day: How ESTRO strives to close the care gap - PDF Version

On 4 February each year, World Cancer Day, a global initiative led by the Union of International Cancer Control (UICC), reminds us of the need to work together to raise awareness, improve education and engage in healthcare policy to reduce the number of preventable cancer deaths each year. This year’s theme, “close the care gap”, is focused on the improvement of access to high-quality cancer care and reductions in inequities. The 2030 vision statement of the European SocieTy for Radiotherapy and Oncology (ESTRO) ‑ “Radiation Oncology, Optimal Health for All, Together” ‑ remains pertinent but how is ESTRO’s vision being effected now in relation to reducing inequities?

First, ESTRO connects professionals of all disciplines who work in radiation oncology in multiple areas, from the clinical coalface to the laboratory. The forthcoming annual congress, ESTRO 2023, is themed “from innovation to action”, and the presidential symposium will focus on bridging four distinct cancer-care gaps: evidence (what do we need to ensure innovations are implemented routinely), translation (including overcoming regulatory and reimbursement barriers), access (how to design and deliver healthcare in a way that ensures optimal access for all), and outcomes (how can we reduce outcome disparities in patients who receive similar treatments at different locations).

Second, ESTRO supports the development and dissemination of evidence-based guidelines across a range of clinical and technical scenarios. Recent guidelines on fractionation in breast cancer radiotherapy(1), for example, will help to underpin changes in practice that could have a huge impact on the availability of radiotherapy resources globally.

Third, the ESTRO School provides breadth and depth in education and training across radiation oncology and it unites our experienced faculties with all who are keen to learn. Different courses are given in different geographical locations according to the needs of our members and the global radiation oncology community. The portfolio of online courses also continues to grow, which enables the delivery of high-quality educational content to a wide audience.

Advocacy is another key area of ESTRO activity that has been evolving over the years, addressing constantly the need to close the care gap. The ESTRO health economics in radiation oncology (HERO) project, launched in 2010, aims to equip the radiotherapy community with in-depth insight into the provision and accessibility of radiotherapy in Europe. HERO has highlighted the heterogeneity of access to radiotherapy among European nations. To action these findings, the ESTRO Cancer Foundation – established in 2012 – has worked towards the removal of the barriers that prevent patients from accessing the treatment they need. The 2017 Marie Curie legacy campaign, which was launched on what would have been Marie Curie’s 150th birthday, highlighted some HERO findings, particularly that one-in-four cancer patients who could benefit from radiotherapy were unable to access it. By 2035, if every patient who needed radiation therapy could access it, one million more lives would be saved every year. Key recommendations of this plan included making radiation therapy a central component of cancer-care policies and budgets, achieving recognition of all radiotherapy professions across Europe, investing in research and data collection to improve outcomes, and improving awareness and understanding of radiation therapy as a key curative tool in the cancer care armamentarium. Expanding on the HERO methodology, alongside the efforts of the UICC global task force on radiotherapy for cancer control and the expertise of the International Atomic Energy Agency (IAEA), the Global Impact Radiotherapy in Oncology (GIRO) network was created. GIRO is a platform that connects international experts who are interested in the development of radiotherapy globally and whose ultimate goal is to close the gap in radiotherapy access. The latest article published under the aegis of GIRO, in November 2022, addressed whether the inclusion of radiotherapy in national radiation oncology programmes correlated with radiotherapy machine availability, national income and geographic region(2).

Today, ESTRO continues to work in partnership with other international organisations to increase global access to the highest quality radiation therapy. In 2022, the International Radiation Oncology Network (IRON) was formed as a global group that comprised several large, regional, radiation oncology organisations including ESTRO. The aim was to identify global challenges in radiation oncology and to act as a coordinated international community. ESTRO past president Ben Slotman has become IRON’s inaugural president. The role will be rotated annually among partner organisations. ESTRO is also working in partnership with international organisations through the IAEA Rays of Hope Programme, which is aimed to improve access to radiation therapy resources in low- and middle-income countries that have the biggest gaps between the need for and the provision of those resources.

In the meantime, ESTRO is here to support its members in their individual and collective efforts to provide the highest-quality cancer care to their patients alongside sharing their expertise for the benefit of as many patients as possible worldwide. Thank you all for playing your part in closing the care gap.


Anna Kirby
ESTRO president


  1. Meattini I, Becherini C, Boersma L, Kaidar-Person O, Marta GN, Montero A, Offersen BV, Aznar MC, Belka C, Brunt AM, Dicuonzo S, Franco P, Krause M, MacKenzie M, Marinko T, Marrazzo L, Ratosa I, Scholten A, Senkus E, Stobart H, Poortmans P, Coles CE. European Society for Radiotherapy and Oncology Advisory Committee in Radiation Oncology Practice consensus recommendations on patient selection and dose and fractionation for external beam radiotherapy in early breast cancer. Lancet Oncol. 2022 Jan;23(1):e21-e31. doi: 10.1016/S1470-2045(21)00539-8. PMID: 34973228.
  1. Wilson BE, Oar A, Rodin D, Bray F, Perlay J, Polo A, Borras JM, Bourque JM, Malik M, de Moraes FY, Lievens Y, Stevens LM, Zubizarreta E, Yap ML. Radiotherapy prioritization in 143 national cancer control plans: Correlation with radiotherapy machine availability, geography and income level. Radiotherapy and Oncology 2022 Nov;176:83-91 (