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Estimating the Global Demand and Delivery of Cancer Surgery

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Abstract

Background

Cancer is a leading cause of death and disability globally. While surgery remains a vital part of cancer management, access to surgical care remains inconsistent. Our objective was to estimate the global need for cancer-related surgery and to identify disparities in the surgeon workforce.

Methods

The World Health Organization International Agency for Research on Cancer and the Global Cancer Observatory were queried for estimates on national incidences of 35 different malignancies. The proportion of patients requiring surgery for each of these cancers was extrapolated from the United States Surveillance, Epidemiology and End-Result database. The number of people requiring cancer surgery in each country was calculated and compared with the surgical workforce. Estimates were presented as choropleth maps. Associations were tested with country development indicators.

Results

An estimated 9,464,214 (95% CI 4,364,196–14,564,230) patients required cancer-related surgical care in 2018. An overall 1.24 people needed cancer surgery per 1000 population. This was related to income status (p < 0.01) and Human Development Index (r = 0.86, p < 0.001), with the largest need being in high-income countries. The number of people requiring cancer surgery per surgeon (CP–S ratio) ranged from 7.3 in the European region to 80 in the African regions. The CP–S ratio was 10 times higher for low- versus high-income countries (p < 0.001) and was inversely related to healthcare expenditure (r = −0.59, p < 0.001).

Conclusions

An estimated 9.5 million people required cancer surgery globally. Low- and middle-income countries experience a severe and acute shortage of surgeons to provide for the cancer surgery needs of the population.

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Authors and Affiliations

  1. Department of Surgery, University of Maryland, Baltimore, MD, USA

    Syed Nabeel Zafar & Andrea Bafford

  2. Department of Surgical Oncology, MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA

    Syed Nabeel Zafar

  3. Department of Surgery, Aga Khan University, Karachi, Pakistan

    Asif H. Siddiqui

  4. Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA

    Roomasa Channa

  5. Dubai Health Authority, Dubai, UAE

    Shayan Ahmed

  6. Johns Hopkins School of Public Health, Baltimore, MD, USA

    Shayan Ahmed

  7. Division of Surgical Oncology, Department of Surgery, Johns Hopkins Medical Institute, Baltimore, MD, USA

    Ammar A. Javed

Authors
  1. Syed Nabeel Zafar
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  2. Asif H. Siddiqui
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  3. Roomasa Channa
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  4. Shayan Ahmed
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  5. Ammar A. Javed
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  6. Andrea Bafford
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Correspondence to Syed Nabeel Zafar.

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Zafar, S.N., Siddiqui, A.H., Channa, R. et al. Estimating the Global Demand and Delivery of Cancer Surgery. World J Surg 43, 2203–2210 (2019). https://doi.org/10.1007/s00268-019-05035-6

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  • DOI: https://doi.org/10.1007/s00268-019-05035-6

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