A social enterprise startup, using technology developed at UNC, aims to close the growing global cancer treatment disparity by providing cost-effective, personalized radiation therapy to cancer clinics in low- to middle-income countries.
Sha Chang, professor of physics at UNC, founded EmpowerRT in 2017, after she said she realized that much of high-income countries' knowledge and innovation is not shared with poorer countries.
Cancer is currently the second leading cause of death worldwide. More than 70 percent of all cancer deaths occur in low- and middle-income countries, according to World Health Organization data.
Cancer mortality in more developed countries is expected to decrease by about 30 percent by 2030, while it is expected to increase more than 70 percent in less developed countries, according to a National Cancer Institute report.
One of the factors contributing to this trend is a lack of access to potentially curative therapy in less developed countries.
“Bringing modern radiotherapy treatments to low- and middle-income countries has been a challenge for a lot of major vendors, because the infrastructure and the resources are just not ready to take on all the high-tech products that are being produced,” Parth Amin, EmpowerRT’s director of partnerships, said.
EmpowerRT addresses this issue by modifying existing radiation therapy machines in developing countries at five to 10 percent of the cost of purchasing modern machines and technology.
Upgrading an existing machine or purchasing a new one capable of delivering intensity-modulated radiation therapy would be expensive, costing clinics at least $500,000, which is money Chang said they do not have.
The existing machines in these countries are often basic and are not equipped to deliver intensity-modulated radiation therapy, which targets cancerous areas more effectively by preserving more healthy tissue. This treatment has been the standard of care in the United States for the last 25 years because it results in better outcomes and lower treatment toxicity.
EmpowerRT’s solution can modify any radiation therapy machine to deliver intensity-modulated radiation therapy using its software.
The clinical software EmpowerRT uses was created over the span of three decades at UNC, and Chang was one of the many researchers instrumental in its development. UNC Hospitals used this software for 25 years, until it was replaced by million-dollar commercial software purchased in 2016.
EmpowerRT’s software designs a patient-specific shape of compensator that will maximize the radiation dose to the cancer tissue while minimizing dosage to healthy tissue. A machine then creates a tumor-specific compensator mold from inexpensive, recyclable styrofoam. Afterward, the compensator is inserted into a standard radiotherapy machine and the improved treatment begins.
EmpowerRT’s solution is clinically proven since its software has been used to treat more than 22,000 cancer patients across the United States, with more than 1,500 patients being treated at UNC Hospitals, Chang said.
Chang said EmpowerRT is giving UNC technology a second life where it is still needed in the world.
“Making an advancement does not mean we need high-tech,” Chang said. “It does not mean we need millions of dollars. There are so many alternatives and doing something sensible with simplicity and that empowers people — that’s what I’m passionate about.”
Although the technology has been successful in more developed countries, one of EmpowerRT’s first steps was proving that it is a feasible solution in less developed countries.
Cancer Diseases Hospital in Zambia was identified as the company’s first test site. EmpowerRT has spent the past two years working on implementation, with five weeks spent on site in Zambia installing the software and hardware and training the employees on the necessary procedures. EmpowerRT will return to Zambia for the first patient treatment this March.
“The hope is that this will transform care at this hospital and that this hospital will generate a reputation for taking a giant step forward in a very cost-effective way to get world class treatment and then other hospitals will want to bring in Sha’s platform,” said Paul Domanico, senior director of Global Health Sciences at the Clinton Health Access Initiative, who connected Chang with the hospital in Zambia.
Since EmpowerRT demonstrated its ability to bring the technology to less developed countries, it hopes to find new sites for implementation, such as India.
Currently no clinics are charged for EmpowerRT’s technology and no one on EmpowerRT’s team is paid for their work. But the company is looking to develop a self-sustaining business model in which it will charge for the services provided, consisting primarily of the computer modeling required to configure the software properly.
“Every new person who learns about EmpowerRT is so excited about it, just as I was,” said Cielle Collins, a student volunteer from Brown University who promotes the company on social media. “I think the more new people we can share it to, the more volunteers that we generate and the more visibility that we have, then the more supported the project is.”
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