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Improving Global Surgical Oncology Benchmarks: Defining the Unmet Need for Cancer Surgery in Ghana

  • Surgery in Low and Middle Income Countries
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

The Lancet Commission on Global Surgery (LCoGS) recommended an annual surgical rate at which low- and middle-income countries (LMICs) could achieve most of the population-wide benefits of surgery. However, condition-specific guidelines were not proposed. To inform rates of surgery for cancer, we sought to assess the current met and unmet need for oncologic surgery in Ghana.

Methods

Data on all operations performed in Ghana over a one-year period (2014–15) were obtained from representative samples of 48/124 first-level and 12/16 referral hospitals and scaled-up for nationwide estimates. Procedures for cancer were identified by indication. Using modified LCoGS methodology with disease prevalence, Ghana’s annual rate of cancer surgery was compared to that of New Zealand to quantify current unmet needs.

Results

232,776 surgical procedures were performed in Ghana; 2,562 procedures (95%UI 1878–3255) were for cancer. Of these, 964 (37%) were surgical biopsies. The annual rate of procedures treating cancer was 2115 surgeries/100,000 cancer cases, or 21% of the New Zealand benchmark. Cervical, breast, and prostate cancer were found to meet 2.1%, 17.2%, and 32.1% of their respective surgical need.

Conclusions

There is a large unmet need for cancer surgery in Ghana. Cancer surgery constitutes under 2% of the total surgeries performed in Ghana, an important proportion of which are used for biopsies. Therapeutic operative rate is deficient across most cancer types, and may lag behind improvements in screening efforts. As cancer prevalence and diagnosis increase in LMICs, cancer-specific surgical capacity must be increased to meet these evolving needs.

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Acknowledgements

The authors thank the dedicated volunteers for extracting data needed for the study and Chris Lewis of New Zealand Ministry of Health for providing us with the National Minimum Dataset.

Funding

This study was funded in part by grant R25-TW009345 and D43-TW007267 from the Fogarty International Center, United States National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Department of Surgery, University of Washington, Seattle, WA, USA

    Cameron E. Gaskill, Barclay Stewart & Charles Mock

  2. Department of Surgical Oncology, MD Anderson Cancer Center, Houston, TX, USA

    Cameron E. Gaskill

  3. Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana

    Adam Gyedu, Robert Quansah & Peter Donkor

  4. University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana

    Adam Gyedu

  5. Harborview Injury Prevention and Research Center, Seattle, WA, USA

    Barclay Stewart & Charles Mock

  6. Department of Global Health, University of Washington, Seattle, WA, USA

    Charles Mock

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  1. Cameron E. Gaskill
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Correspondence to Cameron E. Gaskill.

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The Authors declare they have no conflicts of interest.

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Approval for the study was granted by the Committee on Human Research Publications and Ethics of Kwame Nkrumah University of Science and Technology and deemed as exempt by the University of Washington Institutional Review Board.

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Gaskill, C.E., Gyedu, A., Stewart, B. et al. Improving Global Surgical Oncology Benchmarks: Defining the Unmet Need for Cancer Surgery in Ghana. World J Surg 45, 2661–2669 (2021). https://doi.org/10.1007/s00268-021-06197-y

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