Impact of health system interventions to improve access to external beam radiotherapy: a scoping review

Purpose: Access to external beam radiotherapy (EBRT) remains heterogeneous across global health systems, particularly in low- and middle-income countries (LMIC). This scoping review aimed to synthesize evidence on health-system interventions intended to improve EBRT access, characterize their outcomes, and identify promising strategies for sustainable and equitable radiotherapy delivery. Methods: A systematic search of Ovid MEDLINE, Embase, and CINAHL from inception to June 30, 2025, identified studies evaluating system-level interventions to improve EBRT access. Eligible interventions included infrastructure expansion, workforce development, operational redesign, telemedicine, financing, and quality improvement initiatives. Data were extracted in duplicate and narratively synthesized by intervention domain. Results: Across 31 included studies, the most frequent intervention domains were infrastructure expansion (45%), workforce development (35%), operational redesign (29%), telemedicine (26%), referral and navigation (19%), and financial reforms (10%). The majority of studies reported improved radiotherapy utilization, reduced waiting times, and higher treatment completion rates. Multi-component programs that integrate interventions such as infrastructure and workforce expansion, operational redesign, tele-radiotherapy, decentralization through hub-and-spoke models, and protocolization of hypofractionation regimens, workforce, and operational redesign, can be a sustainable strategy to progress towards equitable, system-level programs to improve EBRT access. Conclusion: Health-system interventions can meaningfully expand access to EBRT when they align investments in infrastructure, workforce, and operations. Multi-component, equity-focused strategies hold promise for scalable, high-quality radiotherapy delivery to address access disparities. Future research should adopt standardized access metrics and report equity-stratified outcomes to guide national strategies for sustainable scale-up of EBRT.