Global cancer surgery: delivering safe, aff ordable, and timely cancer surgery
Global cancer surgery: delivering safe, aff ordable, and timely cancer surgery
复制标题
DOI：
10.1016/s1470-2045(15)00223-5
复制
发表时间：
2015-09-01
期刊：
影响因子：
51.1
通讯作者：
Purushotham, Arnie
中科院分区：
文献类型：
--
作者：
Sullivan, Richard;Alatise, Olusegun Isaac;Purushotham, Arnie
在所有资源环境中，手术对于全球癌症护理都是必不可少的。在2015年新增的1520万癌症病例中，超过80%的病例需要手术，有些需要做几次手术。我们估计，到2030年，全球每年将需要4500万例外科手术。然而，全世界只有不到25%的癌症患者真正得到了安全、可靠或及时的手术。这个全球癌症外科委员会以《2030年全球外科手术》为基础，通过分析外科疾病的负担和癌症手术的广度、经济和筹资、通过多国研究加强癌症外科系统的因素、研究议程以及制定这一领域政策的政治因素，审查了全球癌症外科的状况。我们发现，在全球癌症手术领域，存在着巨大的公平和经济差距。世界各地的许多患者无法接受癌症手术，如果不能培训更多的癌症外科医生并加强系统，到2030年可能导致高达6.2万亿美元的累计国内生产总值损失。许多癌症手术的关键辅助治疗方式--例如病理学和成像--也是不够的。我们的分析发现了重大问题，但也强调了解决方案和创新。可获得性问题、公共外科系统投资不足、研究投资低以及培训和教育差距等问题非常普遍。解决方案包括更好地管理公共系统、国际伙伴关系、外科服务的超级集中、新的外科临床试验，以及通过教育和培训提高质量和扩大癌症外科系统规模的新方法。我们的主要信息是针对全球许多利益攸关方，但核心信息是，为了向所有人提供安全、可靠和及时的癌症手术，手术必须是全球和国家癌症控制规划的核心。
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, aff ordable, 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 fi nancing, 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 identifi ed 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, aff ordable, and timely cancer surgery to all, surgery must be at the heart of global and national cancer control planning.