Improving Global Surgical Oncology Benchmarks: Defining the Unmet Need for Cancer Surgery in Ghana

Abstract

Background The Lancet Commission on Global Surgery (LCoGS) recommended an annual surgical rate at which low‐ and middle‐income countries (LMICs) could achieve most of the population‐wide benefits of surgery. However, condition‐specific guidelines were not proposed. To inform rates of surgery for cancer, we sought to assess the current met and unmet need for oncologic surgery in Ghana. Methods Data on all operations performed in Ghana over a one‐year period (2014–15) were obtained from representative samples of 48/124 first‐level and 12/16 referral hospitals and scaled‐up for nationwide estimates. Procedures for cancer were identified by indication. Using modified LCoGS methodology with disease prevalence, Ghana's annual rate of cancer surgery was compared to that of New Zealand to quantify current unmet needs. Results 232,776 surgical procedures were performed in Ghana; 2,562 procedures (95%UI 1878–3255) were for cancer. Of these, 964 (37%) were surgical biopsies. The annual rate of procedures treating cancer was 2115 surgeries/100,000 cancer cases, or 21% of the New Zealand benchmark. Cervical, breast, and prostate cancer were found to meet 2.1%, 17.2%, and 32.1% of their respective surgical need. Conclusions There is a large unmet need for cancer surgery in Ghana. Cancer surgery constitutes under 2% of the total surgeries performed in Ghana, an important proportion of which are used for biopsies. Therapeutic operative rate is deficient across most cancer types, and may lag behind improvements in screening efforts. As cancer prevalence and diagnosis increase in LMICs, cancer‐specific surgical capacity must be increased to meet these evolving needs.

Assessment of the Surgical Oncology Case Volume Within the Public Sector in Tanzania

“… 12 In the only other similar study in sub-Saharan Africa, 21% of the necessary cancer cases were done in Ghana (2021) using New Zealand as a benchmark for the number of surgeries necessary per cancer case. 15 The causes for the high unmet need for surgical oncology care within the public sector in Tanzania are multifaceted and include barriers such as late-stage diagnosis, financial strain, and limited geographic access. Although these factors were not within the scope of this research study, they affect the country's ability to provide cancer surgery in the country and may be a focus of future work of this group.…”

Inequities in global cancer surgery: Challenges and solutions

“…For example, in some parts of Africa, the ratio of patients needing cancer surgery to available cancer surgeons is 80:1, which is ten times higher than that in Europe 7 . In Ghana, in 2014–15, surgery for cancer constituted only 2% of the total surgical procedures; of these, more than one‐third were surgical biopsies 8 . Compared to benchmarks from HICs, Ghana met only 21% of its required cancer surgery needs 8 .…”

“…7 In Ghana, in 2014-15, surgery for cancer constituted only 2% of the total surgical procedures; of these, more than one-third were surgical biopsies. 8 Compared to benchmarks from HICs, Ghana met only 21% of its required cancer surgery needs. 8 In 2022, India needed 1.4 times the number of surgical oncologists it had, and even this was possibly an underestimate.…”

“…8 Compared to benchmarks from HICs, Ghana met only 21% of its required cancer surgery needs. 8 In 2022, India needed 1.4 times the number of surgical oncologists it had, and even this was possibly an underestimate. 9 The GlobalSurg3 study looked at variation in quality and outcomes of cancer surgery worldwide, and found that compared to 93% of HICs, only 70% of contributing hospitals in LMICs had a provision for oncologists.…”