Global cancer surgery: delivering safe, affordable, and timely cancer surgery - 29/09/15

Doi : 10.1016/S1470-2045(15)00223-5

Richard Sullivan, ProfMD ^a,^b,^⁎ , Olusegun Isaac Alatise, MD ^c, Benjamin O Anderson, ProfMD ^d,^e, Riccardo Audisio, ProfMD ^f, Philippe Autier, ProfMD ^g, Ajay Aggarwal, MD ^a,^h,ⁱ, Charles Balch, ProfMD ^j, Murray F Brennan, Prof SirMD ^k, Anna Dare, MD ^l,^m, Anil D’Cruz, ProfMD ^o, Alexander M M Eggermont, ProfMD ^p,^q, Kenneth Fleming, MD ^r,^s, Serigne Magueye Gueye, ProfMD ^t,^u, Lars Hagander, MD ^v, Cristian A Herrera, MD ^x,^y, Hampus Holmer, BSc ^v, André M Ilbawi, MD ^z,^aa, Anton Jarnheimer, MSc ^v,^w, Jia-fu Ji, ProfMD ^ab,^ac, T Peter Kingham, MD ^k, Jonathan Liberman, MPub&IntLaw ^ad, Andrew J M Leather, MS ^b, John G Meara, ProfMD ^ae, Swagoto Mukhopadhyay, MD ^ae, Shilpa S Murthy, MD ^af,^ag, Sherif Omar, ProfMD ^ah, Groesbeck P Parham, ProfMD ^ai,^aj, C S Pramesh, ProfMS ^o, Robert Riviello, MD ^af, Danielle Rodin, MD ⁿ, Luiz Santini, ProfMD ^ak, Shailesh V Shrikhande, ProfMD ^o, Mark Shrime, MD ^ae, Robert Thomas, ProfMD ^al, Audrey T Tsunoda, MD ^am, Cornelis van de Velde, ProfMD ^an, Umberto Veronesi, ProfMD ^ao, Dehannathparambil Kottarathil Vijaykumar, ProfMD ^ap, David Watters, ProfMD ^aq,^ar, Shan Wang, ProfMD ^as,^at, Yi-Long Wu, ProfMD ^au,^av,^aw, Moez Zeiton, MRCS ^ax,^ay, Arnie Purushotham, ProfMD ^a,^b,^h

^a Institute of Cancer Policy, King’s Health Partners Comprehensive Cancer Centre, London, UK

^b King’s Centre for Global Health, King’s Health Partners and King’s College London, London, UK

^c Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria

^d University of Washington School of Medicine, Seattle, WA, USA

^e Fred Hutchinson Cancer Research Center, Seattle, WA, USA

^f University of Liverpool, Liverpool, UK

^g International Prevention Research Institute, Lyon, France

^h Guy’s and St Thomas’ NHS Foundation Trust, London, UK

ⁱ London School of Hygiene & Tropical Medicine, London, UK

^j Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA

^k Memorial Sloan Kettering Cancer Center, New York, NY, USA

^l Centre for Global Health Research, St Michael’s Hospital, Toronto, ON, Canada

^m Department of Surgery, University of Toronto, Toronto, ON, Canada

ⁿ Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada

^o Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India

^p Gustave Roussy Cancer Institute, Villejuif, France

^q University Paris Sud, Orsay, France

^r Green Templeton College, University of Oxford, Oxford, UK

^s Oxford University Hospitals NHS Trust, Oxford, UK

^t University Cheikh Anta Diop, Dakar, Senegal

^u Grand Yoff General Hospital, Dakar, Senegal

^v Paediatric Surgery and Global Paediatrics, Department of Paediatrics, Lund University, Lund, Sweden

^w Department of Clinical Sciences, Lund University, Lund, Sweden

^x Cabinet of the Minister, Ministry of Health, Santiago, Chile

^y Department of Public Health, School of Medicine, Pontificia Universidad Católica, Santiago, Chile

^z University of Texas MD Anderson Cancer Centre, Houston, TX, USA

^aa Union for International Cancer Control, Geneva, Switzerland

^ab Peking University Cancer Hospital and Institute, Beijing, China

^ac Chinese Anti-Cancer Association, Tianjin, China

^ad McCabe Centre for Law and Cancer, Melbourne, VIC, Australia

^ae Program in Global Surgery and Social Change, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA

^af Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard School of Public Health, Boston, MA, USA

^ag Department of General Surgery, Indiana University, Bloomington, IN, USA

^ah Cairo University, Cairo, Egypt

^ai Department of Obstetrics and Gynecology, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA

^aj University of Zambia, Lusaka, Zambia

^ak INCA (Brazilian National Cancer Institute), Rio de Janeiro, Brazil

^al Department of Health & Human Services, Melbourne, VIC, Australia

^am Gyne-Oncology Department, Barretos Cancer Hospital, Barretos, Brazil

^an Department of Surgical Oncology, Endocrine and Gastrointestinal Surgery, Leiden University Medical Centre, Leiden, Netherlands

^ao European Institute of Oncology, Milan, Italy

^ap Department of Gynaecological Oncology, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India

^aq Deakin University, Geelong, VIC, Australia

^ar Barwon Health, Geelong, VIC, Australia

^as Peking University People’s Hospital, Beijing, China

^at Chinese College of Surgeons, Beijing, China

^au Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangzhou, China

^av Guangdong Academy of Medical Sciences, Guangzhou, China

^aw Chinese Society of Clinical Oncology, Beijing, China

^ax Sadeq Institute, Tripoli, Libya

^ay Trauma and Orthopaedic Rotation, North-West Deanery, Manchester, UK

^* Correspondence to: Prof Richard Sullivan, Institute of Cancer Policy, King’s Health Partners Comprehensive Cancer Centre and King’s Centre for Global Health, King’s Health Partners and King’s College London, London SE1 9RT, UK Correspondence to: Prof Richard Sullivan Institute of Cancer Policy King’s Health Partners Comprehensive Cancer Centre and King’s Centre for Global Health King’s Health Partners and King’s College London London SE1 9RT UK

Summary

Surgery is essential for global cancer care in all resource settings. Of the 15·2 million new cases of cancer in 2015, over 80% of cases will need surgery, some several times. By 2030, we estimate that annually 45 million surgical procedures will be needed worldwide. Yet, less than 25% of patients with cancer worldwide actually get safe, affordable, or timely surgery. This Commission on global cancer surgery, building on Global Surgery 2030, has examined the state of global cancer surgery through an analysis of the burden of surgical disease and breadth of cancer surgery, economics and financing, factors for strengthening surgical systems for cancer with multiple-country studies, the research agenda, and the political factors that frame policy making in this area. We found wide equity and economic gaps in global cancer surgery. Many patients throughout the world do not have access to cancer surgery, and the failure to train more cancer surgeons and strengthen systems could result in as much as US$6·2 trillion in lost cumulative gross domestic product by 2030. Many of the key adjunct treatment modalities for cancer surgery—eg, pathology and imaging—are also inadequate. Our analysis identified substantial issues, but also highlights solutions and innovations. Issues of access, a paucity of investment in public surgical systems, low investment in research, and training and education gaps are remarkably widespread. Solutions include better regulated public systems, international partnerships, super-centralisation of surgical services, novel surgical clinical trials, and new approaches to improve quality and scale up cancer surgical systems through education and training. Our key messages are directed at many global stakeholders, but the central message is that to deliver safe, affordable, and timely cancer surgery to all, surgery must be at the heart of global and national cancer control planning.

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