ECC 2015
Majority of cancer patients worldwide have no access to safe surgery
Prof Richard Sullivan - King's College London, London, UK
What is the headline information of your presentation?
We’ve just launched the Lancet Oncology Commission into global cancer surgery here at ECCO. This was a major piece of work which builds on the Lancet Global Surgery 2030 Commission. I’m specifically looking at the provision of cancer surgery globally. It was a huge piece of work: 44 commissioners from all sorts of backgrounds, many who work in low and middle income countries and we’ve really pulled it together to deliver some very high level key messages to develop the future of cancer surgery.
What are the key findings?
The Lancet Oncology Commission for Global Cancer Surgery has five key messages. The first is the essential nature of cancer surgery for cancer control globally. In 2015 something like 80% of new cancer cases will need surgery at some point in their life and we’ve projected that by 2030 the world will need something like 50 million procedures for the control, palliation and diagnosis of cancer. But worryingly, as it stands today, about three-quarters of patients don’t receive safe, affordable or timely cancer surgery. This has potentially a huge economic impact globally. Our projections show that if this continues at the current rate in terms of making no improvements in cancer surgery capability that by 2030 the world will have lost nearly 6 trillion US dollars. I quoted something like 0.5-1.5% of GDP lost per year in every single country. So there’s a real urgent economic, as well as moral, case for improving cancer surgery globally. Within the Commission we also talk a lot about financial protection mechanisms for patients as well, particularly in low and middle income countries.
In terms of developing systems one of the things that we need to do is we need to train more cancer surgeons, both in terms of general surgery and also specialised surgical care. Something like 110 procedures do need specialised cancer surgeons and they also need specialised pathology and imaging and all the pre- and post-operative care. So within the Commission we talk a lot about how to build capability and capacity within a national cancer control framework.
The final two aspects of the commission really focus on research and politics. The first piece is on the research. We’ve seen that less than 5% of global research activity in cancer is dedicated towards surgery. That’s abysmally low and one of the key messages to research funders is this needs to increase. More importantly, this research activity needs to increase in emerging and low income countries.
Finally, politically. Surgery, in a big way like radiotherapy, has not been at the table for discussions about how to build national cancer control programmes and in the future it needs to be there. That’s a job both for the surgical community, to make sure that they turn up at these meetings, but also to ensure that the World Bank, WHO and other bodies also recognise the central importance of cancer surgery and make sure that they’re always there.
Compared to new expensive drugs, does surgery provide better value for money for governments?
One of the major findings from the Lancet Oncology Commission in Global Cancer Surgery is just how cost effective cancer surgery is. It’s responsible for well over 50% of the total cure and control of cancer. You can train and develop systems in a very cost-effective, affordable manner, particularly in comparison to things like medicines, for example, particularly expensive molecular targeted agents. Cancer surgery provides immense value to countries both in terms of delivering higher control rates, higher cure rates and better economic returns on investment.
Currently in the UK the NHS is potentially being underfunded. Why should surgery get more funding?
One of the elements of the Lancet Oncology Commission in Global Cancer Surgery was to look as well at high income countries, it wasn’t simply about low and middle income countries, and within that, the models of care and the issues in terms of where we should be spending increasingly shrinking resources. The reality is it’s not just a matter of putting more money into, say, cancer surgery, there also needs to be significant structural and organisational changes, for instance in delivering high volume centres. We know that centres that deliver high volumes of surgery have better outcomes and the reality is across many high income countries that nettle has still not been grasped. There are major barriers of culture, politics, even fiscal barriers to doing the right thing. So we need two things: we need investment but it needs to be investment with structural and organisational changes in high income countries.
