What is the Optimum Utilization of Cancer Surgery in High Income Settings? A National Population Based Analysis

Abstract

Background: Estimating the optimum rate for utilization of surgery in the management of cancer helps to identify treatment gaps, estimate the survival impact of such gaps and to calculate the optimum workforce and other resources including budgets required to meet service needs. A population-based benchmark rate for optimum surgical utilization in high income settings has not been developed to inform policymakers and service provision but was recommended by the Lancet Oncology Commission into Global Cancer Surgery. Here we have developed and validated the first such instrument. Methods: The latest clinical guidelines were examined, and surgical treatment pathways were mapped for each cancer, broadly reflecting contemporary high income models of care. The optimum utilization of surgery was considered as an indication for surgery where surgery is the treatment of choice for a given clinical scenario. The population based epidemiological data such as stage of cancer, tumour characteristics, and fitness for surgery were derived from Australia and other comparable high-income settings. The probabilities across the clinical pathways of each cancer was multiplied and added together to estimate the optimum rates of cancer surgical utilization and compared with actual rates of utilization. Findings: Surgical treatment is indicated in 58% (95% CI 57% to 59%) of newly diagnosed cancer patients in Australia, at least once during the course of their treatment but varies between 22% and 99% for site specific cancers. The actual utilization was higher for some cancers including prostate, head &neck and cervix, whereas it was lower for other cancers such as lung, ovary and pancreas. Interpretation: There are discordances in modelled versus actual utilisation rates that require more in depth analysis. This approach provides a new template for other high income and emerging economies to rationally plan and assess their cancer surgery provision. Funding Statement: University of New South Wales Scientia Scholarship. Declaration of Interests: The authors declare no conflicts of interest. Ethics Approval Statement: The data on the actual surgical utilization from the South Western Sydney Clinical Cancer Registry was obtained with necessary ethical clearance.