04 FEBRUARY 2019 / Strengthening Greece’s Arsenal in the Battle against Cancer

For Katie Theodorou, it’s cooking magazines. “I find that a waiting room with cooking magazines can be comforting.”

Just as people face differing challenges in their battles with cancer, they draw strength, comfort, and hope from different sources. 

One source of support that everyone should be able to rely on, though, is access to the very best tools and technique available in the fight against the disease. Unfortunately, in Greece, access to these resources can be uneven. Patients may travel for hours to receive examinations, surgery, and treatment, and may have to wait for months to begin radiotherapy treatment.

These cases are not far removed from our reality—they can affect our parents, our husbands, our wives, our sisters, our children, our friends, me and you. The philosophy that guides our efforts to strengthen the health sector is that everyone has the right to high-quality diagnostic and treatment services. We saw a great opportunity to act on this belief when we were approached by two hospitals in January 2014, first by the General Hospital of Athens Alexandra, and then by the General University Hospital of Alexandroupolis, asking for our support for the replacement of radiotherapy equipment. The meetings with representatives of these two hospitals provided the first seed from which the idea for whole program for the replacement of radiotherapy equipment grew.

The Stavros Niarchos Foundation assembled a team of Program Officers and members of our Technical Department to focus on assessing the needs in radiotherapy equipment throughout Greece. In collaboration with specialized consultants, we studied international projects of similar scope, and got in contact with the relevant authorities, namely the Hellenic Society for Radiation Oncology and the Hellenic Association of Medical Physicists. We then visited hospitals across the country and got a better picture of the situation on the ground in terms of deficiencies in radiotherapy, and, by extension, in terms of the consequences for treating patients.

In Greece, each year, more than 28,000 people require radiotherapy. Approximately 4,000 of these people fail to enter a radiotherapy program, due to shortage of equipment and long waiting times. Furthermore, in Greece, there are 3.8 linear accelerators per million people, compared to an EU average of 6.5-7. “We saw doctors doing their best to help patients, even though they did not have the proper radiotherapy technology in their hands,” said Dr. Heini Murer, Professor of Physiology at the University of Zurich and SNF Advisor, who participated in visits to public hospitals.

This first survey confirmed our initial assessment that the replacement of radiotherapy equipment in only two of the country’s hospitals wouldn’t be enough to help address this situation as much as we could, and that a more radical approach was needed. Following discussions, we decided, in collaboration with the Hellenic Society for Radiation Oncology and the Hellenic Association of Medical Physicists, to bring in an external consultant with extensive experience in the latest cancer treatment and an objective external view of the situation.

Our search for this consulting partner was directed at the largest hospitals for cancer care in Europe and America. Meetings were held with hospital representatives in Switzerland and the U.S., and finally we decided to work with Johns Hopkins University in Baltimore. A team of four specialized professionals from Johns Hopkins University—the Directors of the Departments of Oncology, Radiotherapy, Radiophysics and Radiotechnology—was formed for the planning and implementation of the program.

Together, representatives of the Stavros Niarchos Foundation and the team from Hopkins traveled throughout Greece. We visited a total of 15 hospitals with radiotherapy units, from Heraklion to Alexandroupolis, and from Athens to Ioannina. Todd McNutt, a radiologist from the Hopkins team of consultants, summed up the prevailing situation: “There were hospitals that could not serve patients, due to inadequate maintenance and damage to the equipment. As a result, the patients were being diverted to other ‘overloaded’ hospitals.”
Following our field trips and discussions, we jointly decided to focus our attention on hospitals whose equipment had exceeded its recommended lifespan and required immediate replacement. In total, the Stavros Niarchos Foundation grant includes the procurement and installation of 10 linear accelerators in seven public hospitals in Greece: Attikon University General Hospital (Athens), the Athens Alexandra General Hospital, Theagenio Cancer Hospital in Thessaloniki, and the University General Hospitals of Alexandroupoli, Larissa, Patras (Rio) and Heraklion.

Based on the research conducted, we selected radiotherapy equipment that offers more features than older technology. In the words of Giorgos Pissakas, radiation oncologist and president of the Hellenic Society for Radiation Oncology, “we are now able to administer a greater dose for tumors, which translates to greater tumor control. At the same time, we are able to reduce side effects, which translates to a better life for patients, both during the treatment period and in the years to follow, since the main goal is the cure.”

However, radiotherapy equipment does not work by magic, at the touch of a button. They include complex functions and require training and expertise to fully utilize their capabilities. Therefore, part of the grant was directed toward the training of scientific staff who would use the equipment. One training program involved demonstration of the capabilities and functions of linear accelerators by representatives of the suppliers. Another three-year training program is being offered in collaboration with the Department of Radiotherapy Oncology of the University of Texas in San Antonio, directed by Professor Nikos Papanikolaou. Two employees from each public hospital that received a grant, one radiotherapist and one radiophysicist, travel to Texas to train on new treatment protocols and new machine capabilities, in order stay abreast of developments in the field of radiotherapy.

Today, all 10 of the linear accelerators are in clinical operation, and the program supports the maintenance of each accelerator for at least two years. “Access to the best possible health care and latest technology should be a given for anyone who needs it, not restricted to a lucky few,” said SNF Co-President Andreas Dracopoulos. “Following this belief, we wanted to do what was within our means to strengthen the ‘arsenal’ of tools available to any patient in their battle against cancer. Today, the radiotherapy technology of seven public hospitals in our country is comparable to that of leading hospitals in Europe and America. This effort is one small step, but we hope that it will help many who are battling cancer.