Not Everyone Has Access to Quality Cancer Surgery, But Global Commission Aims to Change That

Surgery is a primary pillar of cancer care. Almost 80% of patients with solid tumors will need surgery during the course of their cancer treatment. However, in some countries, 9 out of 10 people cannot access even basic surgical care.

A new Lancet Oncology Commission on Global Cancer Surgery is addressing this lack of access. In a report released in November, the commission lays out a roadmap to reduce inequities and promote safe, timely and affordable cancer surgery for all patients.

“It’s important to understand that Moffitt is at the forefront of this,” explained Dr. Daniel Anaya, chief of Gastrointestinal Surgery and head of the Hepatobiliary Section at Moffitt Cancer Center, who served on The Lancet Oncology Commission that developed the report. “As a leading cancer center in the U.S., an important part of our role and service to the community is to help define cancer treatments for patients across the globe. As such, Moffitt recognizes the fact that surgery is critical for cancer care, across all stages and along the whole continuum of the patient journey. In fact, in many cases, including those for the most common and fatal cancers, surgery is the only treatment approach that can alone or in combination provide a cure.”

The commission, which is made up of global cancer surgery leaders from each region of the World Health Organization, looked at the challenges of providing access to surgery through a broad public health lens. It also considered the context of the different geographic locations. It looked at the political, societal, economic and public health context of each location, as well as the cancer epidemiology unique to each region.

The new report builds on findings from the initial Lancet Oncology Commission on Global Cancer Surgery, which were released in 2015. The original report documented the extraordinary need for cancer surgery on a worldwide scale. After eight years of progress, the commission’s new report promotes solutions for addressing inequities in delivering cancer surgical care around the world.

“Surgery is a critical component and driver of cancer care,” Anaya said. “It is critical for prevention, screening, diagnosis, treatment, palliation, surveillance and subsequent treatment. When you consider that, the impact of providing access to high-quality cancer surgery everywhere is substantial. This is true not only for each individual patient, but from a public health perspective that has downstream effects that can positively impact the society as a whole.”

The report presented both global and region-specific solutions intended to improve surgical care. The solutions were presented within the context of nine domains that were selected as areas that need improvement, are most likely to make a substantial difference and have the potential to cover as much of the direct cancer surgical care pathway as possible. These domains are:

• Emphasizing the role of surgery and surgeons in cancer care. Because not everyone understands the value of surgery in cancer care, this requires advocacy in the public health and political spheres, as well as driving investment and innovations in research.
• Basic requirements for establishing or expanding cancer surgery services. This includes setting priorities for preoperative, perioperative and postoperative care, taking into account local epidemiological cancer burden, stage of disease and technical complexity of surgical procedures.
• Incorporation of technology in cancer surgery. The report highlights some of the most important tools needed to meet the current standards for cancer surgery, including minimally invasive approaches, the current role of robotic surgery, imaging studies, intraoperative image-guided technologies and telehealth technologies. It also notes challenges related to disparities in infrastructure, workforce and financial constraints in different regions.
• Other specialties integral to providing optimal cancer surgical care. Work is needed to boost national workforces and clinical training solutions in support of specialties that round out multidisciplinary care teams. This includes medical oncologists, anesthesiologists, pathologists, radiation oncologists, radiologists, nurses and palliative care specialists.
• Patient safety and quality improvement in cancer surgery. The report notes that improvements must go beyond access to surgical care. To improve safety and quality, it recommends maximizing multidisciplinary teams (through telehealth if necessary), using safety checklists to reduce surgical complications and collecting outcomes data to define gaps in care.
• Enhancing the role of research in cancer surgery. Some of the solutions in this domain include developing research workshops in medical schools and residency programs, establishing mentorships, providing advanced degrees in research, innovating finance models to provide research funding, and developing cancer registries, databases and biobanks.
• Education of the surgical workforce pertaining to cancer surgery. Solutions include emphasizing surgical oncology in medical schools, strengthening domestic fellowship programs, and fostering national and international partnerships.
• Economic effect of providing safe, timely, high-quality and value-based cancer surgery. This involves making cost-effective structural investments, rethinking and funding training pathways, promoting screening, and increasing participation in insurance, among other recommendations.
• Scaling up the cancer surgical workforce. The report notes that this will involve a wide range of actions, including accurately assessing workforce shortages, increasing education and training with a standardized curricula, centralizing complex care and decentralizing basic operations, investing in remote learning and mobile health, and engaging in national and international collaborations.

Anaya notes that Moffitt is already involved in many aspects of facilitating cancer surgery and other cancer treatments for patients throughout the United States and around the world. The cancer center is working to narrow the gap in surgical care by increasing access and quality through many initiatives and collaborations, including education, wellness, outreach, system development, digital development and research.

“The new frameworks and solutions presented by The Lancet Commission are a huge step in opening the door to make sure that people around the world have access to a high-quality level of cancer surgery, such as the one we provide at Moffitt,” he said.