Global demand for cancer surgery will increase 52% by 2040, with low- and low-income countries receiving 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 death after surgery for gastric or colorectal cancer.
Together, the studies highlight an urgent need to strengthen resources and capacity to help meet demand in poorer countries, the authors agree.
“Policymakers around the world need to balance investments in early detection and treatment of cancer with the simultaneous development in safe perioperative care. Without these investments, fully realize the benefits of mortality in cancer control, “they warn.
Increase in demand
For the modeling study, published online on January 21 in Oncology Lancet, researchers estimated demand for cancer surgery between 2018 and 2040 in 183 countries.
The analysis showed 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 double.
In addition, it is estimated that, worldwide, there will be a shortage of 199,000 surgeons and 87,000 anesthetists. These staffing levels are 26% and 24% below the optimum, respectively.
Again, the greatest shortages were in low-income countries. In these countries, the numbers of surgeons and anesthetists need to more than double to keep up with the expected 2040 demand. To match the current rates of high-income countries, the numbers need to increase by nearly 400% and 550%, respectively, the authors note .
The authors, led by Sathira Kasun Perera, MSc, of the Collaboration for Research and Evaluation of Cancer Outcomes, University of New South Wales, Sydney, Australia, conclude that the gaps are likely to widen without swift action. “to ensure that the human resources required for cancer are adequately planned, especially in socially and economically changing countries.”
Worse results in lower-income countries
The second study was conducted by the GlobalSurg Collaborative Global Health Research Unit and National Institute for Health Research on Global Surgery and was published online January 21 in The Lancet.
It provides “a unique set of prospective data of patients undergoing breast, colorectal, and gastric cancer worldwide,” the authors say.
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 middle-income countries died at a much higher rate than those in low-income countries. high (63 deaths among 905 patients, vs. 94 among 4142 patients; ratio for deaths [aOR], 4.59). Moreover, those in high-income countries were approximately twice as likely to die compared to those in high-income countries (47 among 1102 patients; aOR , 2.06).
Patients in low-income countries who underwent surgery for gastric cancer were at higher risk for death compared 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 from major surgery complications was six times higher in low- and middle-income countries and it was almost four times higher in high-income countries compared to high-income countries. (aOR, 6.15 and 3.89, respectively). The differences were not due solely to the degree of cancer at the presentation, the authors note.
Future research should focus on the detailed identification of perioperative care processes and the implementation of strategies to reduce complex rates and free patients from complications when they occur, they conclude.
“Increasing this ability to save patients from complications could help reduce post-surgery cancer deaths in low- and middle-income countries,” the co-author added. -responsible Ewen M. Harrison, MD, Global Health Research Unit of the National Institute for Health Research on Global Surgery, University of Edinburgh, Edinburgh, United Kingdom, in a press release.
The modeling study was funded by the University of New South Wales and the UK Global Research and Innovation Challenge Fund. The study on cancer outcomes was funded by the National Institute for Health Research. Perera and Harrison did not disclose material financial relationships.
Lancet Oncol. Published online January 21, 2021. Summary
Lancet. Published online January 21, 2021. Full text
Sharon Worcester is a reporter for MDedge News, part of the Medscape Professional Network.
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