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Estimating the Global Demand and Delivery of Cancer Surgery

Abstract

Background

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.

Methods

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.

Results

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).

Conclusions

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.

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References

  1. WHO Fact Sheets: Cancer. https://www.who.int/news-room/fact-sheets/detail/cancer. Accessed 10 Mar 2019

  2. GBD-Cause of Death Collaborators (2016) Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 388:1459–1544

    Article  Google Scholar 

  3. Bray F, Jemal A, Grey N et al (2012) Global cancer transitions according to the Human Development Index (2008–2030): a population-based study. Lancet Oncol 13:790–801

    Article  PubMed  Google Scholar 

  4. Meara JG, Leather AJ, Hagander L et al (2015) Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet 386:569–624

    Article  PubMed  Google Scholar 

  5. Sullivan R, Alatise OI, Anderson BO et al (2015) Global cancer surgery: delivering safe, affordable, and timely cancer surgery. Lancet Oncol 16:1193–1224

    Article  PubMed  Google Scholar 

  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 387:2133–2144

    Article  PubMed  Google 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 Reports

  12. Holmer H, Lantz A, Kunjumen T et al (2015) Global distribution of surgeons, anaesthesiologists, and obstetricians. Lancet Glob Health 3(Suppl 2):S9–S11

    Article  PubMed  Google 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/

  15. Siddiqui AH, Zafar SN (2018) Global availability of cancer registry data. J Glob Oncol 4:1–3

    Article  PubMed  Google Scholar 

  16. Alkire BC, Raykar NP, Shrime MG et al (2015) Global access to surgical care: a modelling study. Lancet Glob Health 3:e316–323

    Article  PubMed  PubMed Central  Google Scholar 

  17. Group AS, Jan S, Kimman M et al (2015) Financial catastrophe, treatment discontinuation and death associated with surgically operable cancer in South-East Asia: results from the ACTION study. Surgery 157:971–982

    Article  Google Scholar 

  18. Grimes CE, Henry JA, Maraka J et al (2014) Cost-effectiveness of surgery in low- and middle-income countries: a systematic review. World J Surg 38:252–263. https://doi.org/10.1007/s00268-013-2243-y

    Article  PubMed  Google Scholar 

  19. WHO Cancer Prevention and Control in the Context of an Integrated Approach, Geneva, 2016

  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 391:1023–1075

    Article  PubMed  PubMed Central  Google Scholar 

  21. Znaor A, Eser S, Anton-Culver H et al (2018) Cancer surveillance in northern Africa, and central and western Asia: challenges and strategies in support of developing cancer registries. Lancet Oncol 19:e85–e92

    Article  PubMed  Google Scholar 

  22. Rajaram S, Malik R, Agarwal S et al (2013) The role of hospital-based cancer registries in low and middle income countries-Indian statistics. Cancer Epidemiol 37:e7

    Article  PubMed  Google Scholar 

  23. Wilson ML, Fleming KA, Kuti MA et al (2018) Access to pathology and laboratory medicine services: a crucial gap. Lancet 391:1927–1938

    Article  PubMed  Google Scholar 

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Correspondence to Syed Nabeel Zafar.

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Zafar, S.N., Siddiqui, A.H., Channa, R. et al. Estimating the Global Demand and Delivery of Cancer Surgery. World J Surg 43, 2203–2210 (2019). https://doi.org/10.1007/s00268-019-05035-6

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  • DOI: https://doi.org/10.1007/s00268-019-05035-6