Over Three-Quarters of People With Cancer Worldwide Have No Access to Safe Surgery

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Richard Sullivan, MD, PhD

The evidence outlined by the Commission … leaves no doubt of the dire situation we are facing. It is imperative that surgery is at the heart of global and national cancer plans.

—Richard Sullivan, MD, PhD

Over 80% of the 15 million people diagnosed with cancer worldwide in 2015 will need surgery, but less than one-quarter of them will have access to proper, safe, affordable surgical care when they need it, according to a major new Commission examining the state of global cancer surgery. The Commission’s findings were published by Sullivan et al in The Lancet Oncology1 and presented at the 2015 European Cancer Congress in Vienna, Austria.2

The Commission revealed that access is worst in low-income countries, where as many as 95% of people with cancer do not receive basic cancer surgery. Yet despite this worldwide shortfall in access to cancer surgery, the international community does not see surgical care as an essential component of global cancer control.

Lead Commissioner Richard Sullivan, MD, PhD, of the Institute of Cancer Policy, King’s Health Partners Comprehensive Cancer Centre, King’s College London, said, “With many competing health priorities and substantial financial constraints in many low- and middle-income countries, surgical services for cancer are given low priority within national cancer plans and are allocated few resources. As a result, access to safe, affordable cancer surgical services is dismal. Our new estimates suggest that less than one in 20 (5%) patients in low-income countries and only roughly one in five patients (22%) in middle-income countries can access even the most basic cancer surgery.”

Poor access to basic cancer surgery and good quality cancer care is not just confined to the world’s poorer countries. Survival data across Europe show that many of the poorer European Union member states are not delivering high-quality cancer surgery to their populations.

Economic Losses

Without urgent investment in surgical services for cancer care, global economic losses from cancers that could have been treated by surgery will reach a staggering USD $12 trillion by 2030, equivalent to 1% to 1.5% of economic output in high-income countries, and 0.5% to 1% in low- and middle-income countries every year. Furthermore, the lack of effective action to train more cancer surgeons and improve cancer surgical systems could cost the global economy more than USD $6 trillion between now and 2030, said coauthor John Meara, MD, DMD, MBA, Director of the Program in Global Surgery and Social Change at Harvard Medical School.

The demand for cancer surgery is growing as many of the worst affected countries face rising cancer rates. By 2030, of the almost 22 million new cancer patients, over 17 million will need operations, 10 million of them in low- and middle-income countries. “The global community can no longer ignore this problem,” said coauthor C. S. Pramesh, MS, FRCS, Head of Thoracic Surgery at Tata Memorial Hospital.

The Commission also revealed that one-third of people with cancer in low- and middle-income countries who have a surgical procedure will incur financial catastrophe. Another quarter will stop treatment because they cannot afford it.

Training and Funding

With a serious shortfall of cancer surgeons in over 82% of countries, radical action is needed to train general surgeons to deliver basic cancer surgery; produce more gynecologic and surgical oncologists; and create more high-quality surgical training programs, said the authors. Other solutions to improve access to surgery include better-regulated public systems; growing international partnerships between institutions and surgical societies; and a firm commitment to universal health coverage.

Educating policymakers, patients, and the public about the key issues in delivering safe, affordable, timely surgical care is also essential, said the authors. “Policy makers at all levels still have little awareness of the central importance of surgery to cancer control. Even recent studies of capacity building for cancer systems in Africa barely acknowledged the importance of surgery, focusing mainly on chemotherapy instead,” said coauthor Riccardo Audisio, MD, President of the European Society for Surgical Oncology.

According to the Commission, funding for research in cancer surgery is dire and needs urgent investment. Despite its huge impact on patient outcomes, just 1.3% of the annual global cancer research and development budget goes toward surgery.

“This Commission clearly outlines the enormous scale of the problem posed by the global shortfall in access to cancer surgery and current deficiencies in pathology and imaging,” Dr. Sullivan said. “The evidence outlined by the Commission, contributed by some of the world’s leading experts in the field, leaves no doubt of the dire situation we are facing. It is imperative that surgery is at the heart of global and national cancer plans. A powerful political commitment is needed in all countries to increase investment and training in publicly funded systems of cancer surgery.” ■

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1. Sullivan R, Alatise OI, Anderson BO, et al: Global cancer surgery: Delivering safe, affordable, and timely cancer surgery. Lancet Oncol 16:1193-1224, 2015.

2. Sullivan R, Olusegun IA, Anderson BO, et al: Delivering safe and affordable cancer surgery to all. 2015 European Cancer Congress. Abstract 9LBA. Presented September 28, 2015.