Building upon recommendations from the 2015 Lancet Oncology Global Cancer Surgery Commission, a new Commission report aims to provide a pragmatic roadmap for decision-makers to reduce inequities and promote safe, timely, and affordable cancer surgery for every patient.
Surgical Roadmap to Reduce Inequities, Promote Access
Nearly 80% of patients with solid tumors will need surgery during the course of their disease. However, in some countries, 9 out of 10 people cannot access even basic surgical care. With the global burden of cancer and its related morbidity and mortality expected to rise, a new Lancet Oncology Commission sets out a pragmatic roadmap to reduce inequities and promote safe, timely, and affordable cancer surgery for every patient.
Chandrakanth Are, MBBS, MBA, FRCS, FACS
This new report by Chandrakanth Are, MBBS, MBA, FRCS, FACS, and colleagues—a group including global leaders in cancer surgery—emphasizes the importance and extraordinary demand for cancer surgery alongside several insufficiencies and inequalities.
Taking stock of how the cancer surgical landscape has changed over the past 8 years, the authors write: “Although still marginalized in many avenues (eg, visibility, importance, advocacy, and funding), cancer surgery is less of an afterthought in cancer care, but further progress is needed.” This is especially pressing in the context of natural and economic catastrophic events, political instability and conflict, disruptive technologic innovation, and the COVID-19 pandemic—all with impacts on cancer surgery.
Framework, Implementation, and Action
Aimed at cancer surgeons as well as leaders, administrators, elected officials, and health policy advocates, the 2023 Global Cancer Surgery Commission report has three main sections:
- In Section 1, “solution frameworks” in nine domains of cancer surgery are provided. These domains were chosen on the basis of (a) areas that need improvement; (b) those that are most likely to make a substantial difference; and (c) those that have the potential to cover as much of the direct cancer surgical care pathway as possible.
- Section 2 identifies “close-to-implementation” interventions by the World Health Organization region—a refinement of the nine domains. Examples of existing regional initiatives that have either worked well or need further support are also summarized.
- Finally, Section 3 outlines eight broad actions to propel essential improvements in the global capacity for cancer surgery.
Summary
Although the ethical imperative for action is made throughout the paper, the authors also stress the economic case for investment in cancer surgery—exclusive of other surgical treatments, provision of cancer surgery alone would avert $12.1 trillion in direct economic losses worldwide from 2015 to 2030.
“Surgery is not only one of the most cost-effective methods of treatment, but also tends to be more durable for many malignancies. Unfortunately, for most patients, particularly for those in low- to middle-income countries, restricted access to safe, timely, high-quality, and affordable cancer surgical care is a harsh reality.... We hope this Commission offers the practical guidance necessary to overcome these challenges,” the authors conclude.
