Global demand for cancer surgery will increase by 52% by 2040, with underresourced, low-income countries shouldering the greatest burden, a modeling study suggests.
A second study shows that outcomes from cancer surgery are much worse in lower-income countries, with a fourfold increase in the risk of dying after surgery for gastric or colorectal cancer.
Together, the studies highlight an urgent need to bolster resources and capacity to help meet demand in poorer countries, the authors agree.
“Policy makers worldwide must balance investments in the early detection and treatment of cancer with the simultaneous improvement in safe perioperative care. Without these investments, mortality gains in cancer control will not be fully realised,” they warn.
Increase in Demand
For the modeling study, published online on January 21 in The Lancet Oncology, researchers estimated demand for cancer surgery between 2018 and 2040 in 183 countries.
The analysis indicated that, overall, cancer surgery cases would increase from 9.1 million to 13.8 million (an increase of 52%). In 34 low-income countries, the caseload is expected to more than double.
In addition, it is estimated that globally, there will be a shortage of 199,000 surgeons and 87,000 anesthetists. These workforce levels are 26% and 24% below optimal, respectively.
Again, these shortages were greatest in low-income countries. In those countries, the numbers of surgeons and anesthetists will need to more than double to keep pace with anticipated 2040 demand. To match the current levels of high-income countries, the numbers will need to increase by nearly 400% and 550%, respectively, the authors note.
The authors, led by Sathira Kasun Perera, MSc, of Collaboration for Cancer Outcomes Research and Evaluation, the University of New South Wales, Sydney, Australia, conclude that the gaps will likely widen without prompt action “to ensure the human resources needed for cancer surgery are adequately planned for, particularly in socially and economically transitioning countries.”
Outcomes Worse in Lower-Income Countries
The second study was conducted by the GlobalSurg Collaborative and National Institute for Health Research Global Health Research Unit on Global Surgery and was published online January 21 in The Lancet.
It provides “a unique prospective dataset of patients undergoing breast, colorectal, and gastric cancer surgery worldwide,” say the authors.
The study enrolled 15,958 patients from 428 hospitals in 82 countries between April 2018 and January 2019.
The researchers found that patients with colorectal cancer who underwent surgery in low- and lower-middle-income countries died at a much higher rate than did those in high-income countries (63 deaths among 905 patients, vs 94 among 4142 patients; adjusted odds ratio for death [aOR], 4.59). In addition, those in upper-middle-income countries were about twice as likely to die in comparison with those in high-income countries (47 among 1102 patients; aOR, 2.06).
Patients in lower-income countries who underwent surgery for gastric cancer were at increased risk for death in comparison with patients in higher-income countries. No such differences were found for patients with breast cancer.
The study also found that the likelihood of dying within 30 days of a major surgical complication was sixfold higher in low-income and lower-middle-income countries and was nearly fourfold higher in upper-middle-income countries in comparison with high-income countries (aOR, 6.15 and 3.89, respectively). The differences were not attributable solely to cancer stage at presentation, the authors note.
Future research should focus on the detailed characterization of perioperative care processes and the implementation of strategies to reduce complication rates and to rescue patients from complications when they do occur, they conclude.
“Increasing this capacity to rescue patients from complications could help reduce deaths following cancer surgery in low- and middle-income countries,” added corresponding author Ewen M. Harrison, MD, the National Institute for Health Research Global Health Research Unit on Global Surgery, University of Edinburgh, Edinburgh, United Kingdom, in a press statement.
The modeling study was funded by the University of New South Wales and the UK Research and Innovation Global Challenges Research Fund. The cancer outcomes study was funded by the National Institute of Health Research. Perera and Harrison have disclosed no relevant financial relationships.
Lancet Oncol. Published online January 21, 2021. Abstract
Lancet. Published online January 21, 2021. Full text
Sharon Worcester is a reporter for MDedge News, part of the Medscape Professional Network.