Daily Radiotherapy Workflow and Waiting-time Performance in a high-volume Cancer Center: Ahsania Mission Cancer and General Hospital: A Retrospective Observational Study

Abstract Background: Bangladesh faces a rapidly increasing cancer burden, yet radiotherapy infrastructure remains critically inadequate. High-volume centers like Ahsania Mission Cancer and General Hospital (AMCGH) struggle to deliver timely treatment due to limited machines and overwhelming patient demand. The aim of this study is to evaluate waiting-time for starting radiotherapy and workflow performance in a resource-limited tertiary cancer center, comparing inpatient and outpatient pathways, documenting emergency care timelines, and assessing treatment interruptions. Materials and Methods: A retrospective observational study was conducted at AMCGH between March and June 2025. Records of 80 consecutive patients receiving external beam radiotherapy (EBRT) were reviewed. Workflow intervals—including referral, consultation, CT-simulation, treatment start, and completion—were extracted from electronic and manual logs. Descriptive statistics and comparative analyses were performed to evaluate waiting times and interruptions. Results: Of 80 patients, 40 were inpatients and 40 were outpatients. Radiotherapy was delivered with curative intent in 72 patients (90%) and palliative intent in 8 (10%). Inpatients were more likely to start radiotherapy within recommended timelines: 60% began within one month of prior treatment, compared with outpatients, 22.5% of whom presented to AMCGH three months after completion of their last treatment. From simulation to treatment, 62.5% of outpatients, initiated radiotherapy within 1–1.5 months, though cumulative delays were substantial. Treatment interruptions occurred in 28 patients (35%), predominantly due to machine downtime and toxicities from treatment. Emergency cases were prioritized with reserved slots, ensuring timely initiation. Conclusion: Despite infrastructure constraints, AMCGH demonstrates resilience in delivering radiotherapy, achieving acceptable timelines for many inpatients through integrated scheduling and prioritization of emergencies. However, prolonged delays among outpatients highlight systemic gaps in national radiotherapy capacity and referral. Expansion of modern radiotherapy infrastructure, strengthened referral pathways, and preventive maintenance strategies are urgently needed to reduce waiting times and improve cancer outcomes in Bangladesh. Keywords: Radiotherapy; Resource-limited settings; Bangladesh