A modeling study of global demand for cancer surgery and estimated surgical and anesthesia workforce requirements between 2018 and 2040 showed a predicted increase, which could especially impact low-income countries. These findings were published by Perera et al in The Lancet Oncology.
Study Methods
Using best-practice guidelines, patient characteristics, and cancer stage data, the authors calculated the proportion of newly diagnosed cancer cases requiring surgery in 183 countries. To predict future surgery demand, they applied these rates to GLOBOCAN cancer incidence predictions for 2018 to 2040.
Current and future surgical and anesthesia workforces needed for the optimal delivery of cancer surgery services were also predicted using staffing estimates based on optimal surgical use in high-income countries as a benchmark for global requirements. To evaluate staffing gaps, the optimal estimated workforce (median workforce of 44 high-income countries) was compared with numbers of surgeons and anesthetists in each country.
"Our analysis has revealed that, in relative terms, low-income countries will bear the brunt of increased future demand for cancer surgery, bringing with it a need to substantially increase numbers of surgeons and anesthetists. These findings highlight a need to act quickly to ensure that increasing workforce requirements in low-income countries are adequately planned for."— Sathira Perera, MSc
Tweet this quote
Predicted Increases
The team's analysis estimated that the number of cancer cases requiring surgery globally each year will rise from 9.1 million to 13.8 million (52%, an increase of 4.7 million) from 2018 to 2040. The greatest relative increase is expected to occur in 34 low-income countries, where the number of cases requiring surgery is expected to more than double by 2040 (314,355 cases to 650,164, 107%).
The authors also estimated there is currently a global shortage of 199,000 (56%) surgeons and 87,000 (51%) anesthetists (current workforce of 766,000 surgeons and 372,000 anesthetists, compared with 965,000 and 459,000 optimal workforce, respectively, estimated by the team's model). The gap is estimated to be greatest in low-income countries, where the current surgeon availability is 22,000 fewer than the model-estimated optimal number of 28,000 surgeons. The current number of anesthetists in low-income countries falls 11,000 below the model-estimated demand of 13,000 anesthetists.
In recognition of the rising global demand for cancer surgery, estimates were calculated for the optimal surgical and anesthesia workforces needed in 2040. Extrapolating 2018 data and taking account of predicted future cancer incidence burden in each country revealed that the surgical workforce will need to increase from 965,000 in 2018 to 1,416,000 (47% increase) in 2040. The anesthetist workforce would need to rise from 459,000 in 2018 to 674,000 (47% increase) in 2040.
The greatest relative increase in optimal workforce requirements from 2018 to 2040 will occur in low-income countries, where surgeon numbers are required to rise from 28,210 to 58,219 by 2040 (106%). Anesthetist numbers will also need to increase from 13,000 to 28,000 by 2040 (115%).
However, to match the current benchmark of high-income countries, the actual number of surgeons in low-income countries would need to increase almost 400% (increase from 6,000 to 28,000), and anesthetists by nearly 550% (increase from 2,000 to 13,000), of their baseline values. This is because the current workforce in these countries is already substantially smaller than in high-income countries.
First study author Sathira Perera, MSc, of the University of New South Wales, Australia, said in a press release, "Our analysis has revealed that, in relative terms, low-income countries will bear the brunt of increased future demand for cancer surgery, bringing with it a need to substantially increase numbers of surgeons and anesthetists. These findings highlight a need to act quickly to ensure that increasing workforce requirements in low-income countries are adequately planned for. There needs to be an increased focus on the application of cost-effective models of care, along with government endorsement of scientific evidence to mobilize resources for expanding services."
Estimates in the study relied on several assumptions. Predictions of future cancer rates were based on 2018 estimates, however, country-level changes—such as economic developments or altered capacity to screen for early diagnosis—could alter cancer incidence and, therefore, surgical demand and workforce requirements. Observed gaps in the workforce could also be narrower than the actual gaps in practice, as predictions were conservative because they only considered initial surgical encounters and did not account for any follow-up interactions.
Disclosure: For full disclosures of the study authors, visit thelancet.com.
