The global demand for cancer surgery is expected to increase from 9.1 million to 13.8 million procedures over the next 20 years, according to new research.
The huge surge in demand for cancer surgery will need an increase of in the workforce of nearly 200,000 surgeons and 87,000 anaesthetics and, the research suggests, improving care systems worldwide must be a priority in order to reduce disproportionate number of deaths following complications.
The findings of two studies, which have been published in The Lancet and The Lancet Oncology, highlight an urgent need to improve cancer surgery provision in low- and middle-income countries.
Global cancer care
Cancer is a leading cause of death across the globe and more than half of cancer patients are required to have surgery at some stage. In recognition of the rising global demand for cancer surgery, the study published in The Lancet Oncology, calculated estimates for the optimal surgical and anaesthesia workforces needed in 2040, revealing that the surgical workforce will need to increase from 965,000 in 2018 to 1,416,000 (47% increase) in 2040. The anaesthetist workforce would need to rise from 459,000 in 2018 to 674,000 (47% increase) in 2040.
The greatest relative increase in optimal workforce requirements from 2018 to 2040 will occur in low-income countries, where surgeon numbers are required to rise from 28,210 to 58,219 by 2040 (106%). Anaesthetist numbers will also need to increase from 13,000 to 28,000 by 2040 (115%).
However, to match the current benchmark of high-income countries, the actual number of surgeons in low-income countries would need to increase almost 400% (from 6,000 to 28,000), and anaesthetists by nearly 550% from 2,000 to 13,000), from their baseline values. This is because the current workforce in these countries is already substantially smaller than in high-income countries.
Dr Sathira Perera, from the University of New South Wales, Australia, said: “Our analysis has revealed that, in relative terms, low-income countries will bear the brunt of increased future demand for cancer surgery, bringing with it a need to substantially increase numbers of surgeons and anaesthetists. These findings highlight a need to act quickly to ensure that increasing workforce requirements in low-income countries are adequately planned for. There needs to be an increased focus on the application of cost-effective models of care, along with government endorsement of scientific evidence to mobilise resources for expanding services.”
Cancer surgery outcomes
The Article in The Lancet found that deaths among gastric cancer patients were nearly four times higher in low/lower middle-income countries (33 deaths among 326 patients, 3.72 odds of death) than high-income countries (27 deaths among 702 patients).
Patients with colorectal cancer in low/lower middle-income countries were also more than four times more likely to die, compared with those in high-income countries. Those in upper middle-income countries were two times as likely to die as patients in high-income countries.
Similar rates of complications were observed in patients across all income groups, however those in low/lower middle-income countries were six times more likely to die within 30 days of a major complication compared with patients in high-income countries. Patients in upper middle-income countries were almost four times as likely to die as those in high-income countries.
Patients in upper middle-income and low/lower middle-income countries tended to present with more advanced disease compared with those in high-income countries, however researchers found that cancer stage alone explained little of the variation in mortality or post-operative complications.
Professor Ewen Harrison, of the University of Edinburgh, UK, said: “Our study is the first to provide in-depth data globally on complications and deaths in patients within 30 days of cancer surgery. The association between having post-operative care and lower mortality rates following major complications indicates a need to improve care systems to detect and intervene when complications occur. Increasing this capacity to rescue patients from complications could help reduce deaths following cancer surgery in low- and middle-income countries.
“High quality all-round surgical care requires appropriate recovery and ward space, a sufficient number of well-trained staff, the use of early warning systems, and ready access to imaging, operating theatre space, and critical care facilities. While in this study it wasn’t possible to assess cancer patients’ full healthcare journey, we did identify several parts of the surgical health system, as well as patient-level risk factors, which could warrant further study and intervention.”
The authors acknowledge some limitations to their study. Researchers only looked at early outcomes following surgery, but, in future, they will study longer-term outcomes and other cancers, and further detailed analysis is needed to provide more robust evidence regarding associations between patient outcomes and hospital facilities.
