Estimating the Global Demand and Delivery of Cancer Surgery
Cancer is a leading cause of death and disability globally. While surgery remains a vital part of cancer management, access to surgical care remains inconsistent. Our objective was to estimate the global need for cancer-related surgery and to identify disparities in the surgeon workforce.
The World Health Organization International Agency for Research on Cancer and the Global Cancer Observatory were queried for estimates on national incidences of 35 different malignancies. The proportion of patients requiring surgery for each of these cancers was extrapolated from the United States Surveillance, Epidemiology and End-Result database. The number of people requiring cancer surgery in each country was calculated and compared with the surgical workforce. Estimates were presented as choropleth maps. Associations were tested with country development indicators.
An estimated 9,464,214 (95% CI 4,364,196–14,564,230) patients required cancer-related surgical care in 2018. An overall 1.24 people needed cancer surgery per 1000 population. This was related to income status (p < 0.01) and Human Development Index (r = 0.86, p < 0.001), with the largest need being in high-income countries. The number of people requiring cancer surgery per surgeon (CP–S ratio) ranged from 7.3 in the European region to 80 in the African regions. The CP–S ratio was 10 times higher for low- versus high-income countries (p < 0.001) and was inversely related to healthcare expenditure (r = −0.59, p < 0.001).
An estimated 9.5 million people required cancer surgery globally. Low- and middle-income countries experience a severe and acute shortage of surgeons to provide for the cancer surgery needs of the population.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflicts of interest.
- 1.WHO Fact Sheets: Cancer. https://www.who.int/news-room/fact-sheets/detail/cancer. Accessed 10 Mar 2019
- 6.Gelband H, Sankaranarayanan R, Gauvreau CL et al (2016) Costs, affordability, and feasibility of an essential package of cancer control interventions in low-income and middle-income countries: key messages from Disease Control Priorities, 3rd edition. Lancet 387:2133–2144CrossRefPubMedGoogle Scholar
- 7.WHO Cancer today (2018) World population fact sheets. In: WHO (ed). https://gco.iarc.fr/today/fact-sheets-populations?population=900&sex=0. Accessed 2 June 2018
- 8.World Health Organization (2019) Cancer profiles. https://www.who.int/cancer/country-profiles/en/. Accessed 8 Apr 2019
- 9.World Bank Country and Lending Groups. https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups
- 10.World Development Indicators: Health Systems (2019) Health systems. https://wdi.worldbank.org/table/2.12. 8 Apr 2019
- 11.UNDP United National Development Programme: Human Development ReportsGoogle Scholar
- 13.National Cancer Institute (2018) Surveillance, epidemiology and end results program. https://seer.cancer.gov/. Accessed 8 Apr 2018
- 14.eSpatial. https://www.espatial.com/
- 19.WHO Cancer Prevention and Control in the Context of an Integrated Approach, Geneva, 2016Google Scholar
- 20.Allemani C, Matsuda T, Di Carlo V et al (2018) Global surveillance of trends in cancer survival 2000–14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries. Lancet 391:1023–1075CrossRefPubMedPubMedCentralGoogle Scholar