Cancer patients are more likely to die after surgery in lower-income countries

A study by an international team of medical experts has found that cancer patients may be up to four times more likely to die after cancer surgery in low- or middle-income countries than in high income countries. It also revealed that income-earning countries are less likely to have post-operative care infrastructure and oncology services.

The global observational study, published in The Lancet, has studied global differences in postoperative complications and post-surgical deaths for three common cancers. It was carried out by researchers from the Collaborative GlobalSurg and the NIHR Global Health Unit on Global Surgery – led by the University of Edinburgh, with analysis and support from the University of Southampton.

Between April 2018 and January 2019, researchers enrolled 15,958 patients from 428 hospitals in 82 countries undergoing surgery for breast, colorectal or gastric cancer. This included a mix of patients from high-income countries, high-income countries and low / low-income countries. 53 percent (8,406) of patients underwent surgery for breast cancer, 39 percent (6,215) for colorectal cancer, and 8 percent (1,337) for gastric cancer. The authors analyzed the incidence of common death or major complications within 30 days of surgery.

Deaths among gastric cancer patients were more than three times higher in low-income / lower-income countries (33 deaths among 326 patients, 3.72 deaths deaths) than high-income countries (27 deaths among 702 patients).

Patients with colorectal cancer in low-income / lower-income countries were also four times more likely to die (63 deaths among 905 patients, 4.59 odds of death), compared with those in low-income countries high (94 deaths among 4,142 patients). Those in high-income countries were twice as likely to die (47 deaths among 1,102 patients, 2.06 deaths gross) than patients in high-income countries.

No difference in 30-day mortality was seen after breast cancer surgery.

Similar levels of postoperative complications were observed in patients across all income groups, but those in low / lower income countries were six times more likely to die within 30 years. days from major trauma (96 deaths among 133 patients, 6.15 deaths per se), compared with patients in high-income countries (121 deaths among 693 patients). Patients in middle middle countries were almost four times more likely to die (58 deaths among 151 patients, 3.89 odds of death) than those in high-income countries.

Patients in moderately high-income countries and low / low-income countries tended to present with more advanced disease compared with those in high-income countries, but researchers found that cancer rate alone did not explain much of the difference in mortality or postoperative complications.

Evaluating hospital facilities and practices across the different income groups showed that hospitals in high- and low-income middle- and lower-income countries were less likely to have an infrastructure of care. have postoperative care (such as designated postoperative rehabilitation areas and regularly available critical care resources) and cancer care pathways (such as oncology services).

Further analysis showed that lack of post-operative care infrastructure was associated with more deaths in low / low-income countries (7 to 10 more deaths per 100 main problems) and high-income countries (5 to 8 more deaths per 100 major problems).

Academic director at the University of Southampton and member of GlobalSurg, Mr Malcolm West, said: “It was a great honor to contribute to this landmark study. If I do not save from death after post-traumatic stressors operation is globally important.Colorectal surgeon, it is inconclusive to see patients in LMIC present with more advanced cancers compared to high-income countries.Interestingly, he did not explain advanced cancer rates alone the higher and more complex mortality rates we have seen.

“An urgent focus on developing global health care systems, particularly in LMIC, would help to detect and intervene when there are life-saving complications following cancer surgery.”

Our study is the first to provide in-depth worldwide data on complications and deaths in patients within 30 days of cancer surgery. The link between receiving postoperative care and lower mortality rates after major complications indicates that the development of care systems to detect and intervene when complications arise may help to reduce post-operative mortality. cancer. “

Ewan Harrison, Professor, University of Edinburgh

The authors acknowledge that there are some limitations in their study. Researchers have only looked at early outcomes after surgery, but, in the future, will study long-term outcomes and other cancers. Results can be poorly captured and misunderstood in situations with few resources, which can affect the team’s decisions on the effectiveness of surgery. More detailed analysis is needed to provide stronger evidence for links between patient outcomes and hospital facilities.