Aims: The growing demand for cancer surgery has placed a global strain on health systems. In-depth analysis of the global demand for cancer surgery and optimal workforce requirements is needed to plan future service provision.
Methods: Using clinical guideline-based models of optimal surgical utilization, the proportion of cancer patients with an indication for surgery was estimated for 180 countries worldwide, stratified by income group. These proportions were multiplied by national estimates of new cases of cancer and then aggregated to obtain the estimated number of surgical procedures required globally. The numbers of cancer surgical procedures in 44 high income countries were divided by the actual number of surgeons and anaesthetists in the respective countries to calculate cancer procedures per surgeon and anaesthetist ratios. Using the 25th percentile, median and 75th percentile of these ratios as benchmarks, a three-tiered optimal surgical and anaesthesia workforce matrix was developed, and the predictions were extrapolated until 2040.
Results: Our model estimates that the number of cancer cases globally with an indication for surgery will increase by 5 million procedures between 2018 (9,066,000) and 2040 (13,822,000), representing a 52% increase. The greatest relative increase in surgical utilization will occur in 34 low-income countries, where significant disparity in the workforce requirements was also observed. In order to match the median benchmark for high-income countries, the surgical workforce would need to increase almost 11-fold and the anaesthetic workforce nearly 18-fold. The greatest increase in optimal workforce requirements from 2018 (28210 surgeons) to 2040 (58219 surgeons) will occur in low-income countries (106%), followed by low- middle-income countries (67%).
Conclusion: The global demand for cancer surgery and the optimal workforce is predicted to increase and disproportionately affect low-income countries. These estimates provide an appropriate framework for planning the provision of surgical services for cancer worldwide.