Making hypofractionated radiation therapy the next standard of cancer care in the Asia Pacific region

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David FamorcaDavid Famorca, Vice President Regional Marketing Asia Pacific and Japan

While the rate of growth in the use of Radiation Therapy (RT) in the Asia Pacific region currently exceeds the overall global average growth rate, with a compound annual growth rate of 6.82 percent compared to six percent, globally1, the difference in availability of high-tech cancer care between the ‘East’ and the ‘West’ is still considerable. Although there is wide diversity in care within the Asia-Pacific region, it still mostly lags profoundly behind other regions, and yet cancer incidence continues to increase.

My professional dream, and I truly hope to see this become a reality, is that the ratio of RT systems to the population in the Asia Pacific Region, particularly the emerging markets in South East Asia, will equal the standards of the West. This needs to correspond with an increase in trained personnel coupled with the proliferation of intelligent & automated solutions. This would ultimately help close the current demand and supply gap and create access to high-tech options for RT treatment of cancer patients in the Asia Pacific region as a standard.

What matters most

I was born in the Philippines, and I am familiar with the region and its healthcare issues. I’ve also traveled extensively and spent chapters of my life in many different parts of the world and am also well aware of what ‘good healthcare systems’ should look like. Most of my family are physicians: my father was a surgeon and mum a nurse. My grandfather, siblings, aunts, uncles, cousins have careers in medicine and healthcare. So, I grew up in a medical
science environment.

I did not become a doctor, because business is my passion. Specifically, the intersection between business and medicine has always held a particular fascination. In developing my career, my father always challenged me to get into a career – not necessarily as a physician – in which I could make a difference in other’s lives and enrich my soul, as well as feel that my efforts were valuable to society.

With that as a ‘North Star’, I focused my career on healthcare and solutions that tackle serious disease. I started at Elekta as an intern, and with the company, have had the chance to progress my career, while dedicating it to something with purpose. I have worked and moved around the world between many countries, establishing high-tech healthcare solutions, and have experienced conditions in over 100 RT centers that serve thousands of patients. What is really rewarding is being able to contribute to improving key statistics for patients and healthcare professionals. This is what we, at Elekta, strive for daily.

Eight years ago, I sadly lost my sister to late-stage colorectal cancer. This has had a huge impact on me. At the time of her diagnosis, she was living in Florida, US, and I was living in Beijing, China. The time between her diagnosis and start of treatment was three weeks, which was very fast compared to what I have witnessed in many of the emerging markets that I have done business in. Because she presented very late, her doctor gave her a prognosis of two to three months to live. The treatment she received enabled her to live for close to another two years, which gave us time to say properly celebrate her life. This intense experience has fueled my passion for bringing precision radiation medicine to all. Precision radiation medicine can extend life expectancy from months to years or even cure.


While there is some growth in the uptake of more sophisticated RT systems in some Asia Pacific markets, there are severe limitations in the number and availability of modern RT systems overall, as well as a significant lack of trained personnel in operating these systems. The lowest number of RT systems and treatment occurs in emerging countries. In the mature markets, the majority of cancer centers have the capacity for hypofractionation, but much of this is not used, due to the lack of trained professionals who are able to administer this precise treatment and a reimbursement system that doesn’t incentivize adoption of such clinically proven treatment modalities.

I hope to see a far greater uptake of RT and hypofractionation in all Asia Pacific markets. The evidence is already emerging that the technique is a more efficient, more accurate, and more economical for many, as treatments per patient are more precise and less treatment sessions are required. With greater knowledge for healthcare professionals and patients alike on RT and hypofractionation and its benefits available through the Internet, there is a pull from the clinical side and a push from the patient side. This has already resulted in a shift towards the purchase of more sophisticated machines that can perform hypofractionation. Reimbursement is a key driver in the increase of the use of the technique in Asia Pacific markets, with established reimbursement centered on fees per treatment fraction, rather than on treatment course.

The value proposition that hypofractionation enables the shift of curative treatment intent from an ambulatory to an out-patient model has many clinical and financial benefits both for the provider and patient. The Covid-19 pandemic has amplified the call for greater use of hypofractionation, because of increased restrictions on hospital visits. Patients and healthcare professionals wish to reduce the time that patients spend in hospitals and centers due to the risk of Covid-19. And while this has meant that less treatments have taken place during the peaks of the pandemic, the potential for minimizing required visits and vastly reducing the required patient time in cancer treatment centers that can be achieved with hypofractionation appeals enormously at later stages of the pandemic.

However, the limitations in the emerging markets in the Asia Pacific region are becoming even more apparent: the low number of currently installed systems that can perform hypofractionation, lack of trained personnel for the systems that exist, and the sheer volume of patients that require treatment, which has been backlogged in the pandemic.

Next standard of cancer care

I am old enough to be able to see what cone-beam CT technology achieved in Radiation Therapy and before the end of my career I hope to see high-field MR-guided enabled hypofractionation as the next evolution and standard of cancer treatment technology. With the right tools, RT can become mainstream in the Asia Pacific region. Our solutions treat patients more precisely, and also can be used to measure the effects of treatment in detail. This helps enormously in driving better outcomes, as well as overall value-based care plans. Hypofractionation has the potential to create the next standard of cancer care, with shorter and faster treatment turnover of patients.


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