Background: Radiotherapy is one of the key pillars in the treatment of patients with cancer. This scoping review aimed to identify the criteria currently used to prioritize patients with cancer for limited radiotherapy services in low-resource settings. Specifically, it examined the challenges encountered in applying such criteria and possible suggestions for improvement.
Methods: The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist and the Joanna Briggs Institute Reviewer’s Manual. Relevant literature was identified through PubMed, Google Scholar, Science Direct, Scopus, and CINAHL. Articles written in English and studies conducted in low- and middle-income countries (LMICs) between 2005 and 2024 were included.
Results: A total of 1,543 articles were identified through database searches. After the removal of 115 duplications, 1,428 records were screened and 1374 were excluded. The full texts of 54 articles assessed, and 44 were excluded due to ineligible concept. 10 articles were retained and included in the review. The included studies from LMICs revealed a range of approaches to prioritizing patients for radiotherapy. These approaches reflected an underlying ethical commitment to maximizing benefit (utilitarian principle) and ensuring fairness through structured decision-making processes. Both clinical and non-clinical criteria—such as disease severity, curability, and patient age—were used to guide prioritization, often categorizing patients into urgency levels (e.g., high, medium, low). In addition to specific criteria, ethical frameworks such as the Accountability for Reasonableness (A4R) framework, which emphasizes transparency, stakeholder relevance, appeals, and enforcement, and goal-oriented ethical frameworks promoting equity, minimizing harm, and integrating broader societal considerations, were applied.
Conclusion: In LMICs, structured approaches to prioritizing patients with cancer for scarce radiotherapy services remain limited. The identified approaches provide a foundation for developing context-appropriate guidelines to ensure radiotherapy is used efficiently and ethically.