Global demand for cancer surgery set to grow by almost 5 million procedures within 20 years

cancer

Demand for cancer surgery is expected to increase from 9.1 million to 13.8 million procedures over the next twenty years, requiring a huge increase in the workforce including nearly 200,000 additional surgeons and 87,000 anaesthetists globally. With access to post-operative care strongly linked to lower mortality, improving care systems worldwide must be a priority in order to reduce disproportionate number of deaths following complications.

The findings of the two studies, published in The Lancet and The Lancet Oncology, highlight an urgent need to improve cancer surgery provision in low- and middle income countries, while also scaling-up their workforces in order to cope with increasing demand. Until now, a lack of data examining outcomes of cancer surgery in different income settings, and an absence of evidence-based estimates of future demand, had limited efforts to improve cancer care globally.

Cancer is a leading cause of death and disability globally, and exerts substantial economic impacts, with recent evidence suggesting a disproportionate burden of disease in LMICs. With more than half of cancer patients predicted to require surgery at some stage, it is a pivotal component of multidisciplinary care globally and plays a key role in preventing deaths. A 2015 study estimated that US$6.2 trillion in global GDP could be lost by 2030 if surgical cancer systems are not improved.

While the new studies did not assess impacts of COVID-19, the authors acknowledge that the delivery of high-quality post-operative care is more challenging during the pandemic.

Increasing future demand

The Article in The Lancet Oncology journal is a modelling study of global demand for cancer surgery and estimated surgical and anaesthesia workforce requirements between 2018 and 2040.

Using best-practice guidelines, patient characteristics and cancer stage data, the authors calculated the proportion of newly diagnosed cancer cases requiring surgery in 183 countries. To predict future surgery demand, they applied these rates to GLOBACAN cancer incidence predictions from 2018 to 2040.

The team’s analysis estimates that the number of cancer cases requiring surgery globally each year will rise from 9.1 million to 13.8 million (52%, an increase of 4.7 million) from 2018 to 2040. The greatest relative increase will occur in 34 low-income countries, where the number of cases requiring surgery is expected to more than double by 2040 (314,355 cases to 650,164, 107%).

Current and future surgical and anaesthesia workforces needed for the optimal delivery of cancer surgery services were also predicted using staffing estimates based on optimal surgical use in high-income countries as a benchmark for global requirements. To evaluate staffing gaps, the optimal estimated workforce (median workforce of 44 high-income countries) was compared with numbers of surgeons and anaesthetists in each country.

The authors estimate there is currently a global shortage of 199,000 (56%) surgeons and 87,000 (51%) anaesthetists (current workforce of 766,000 surgeons and 372,000 anaesthetists, compared with 965,000 and 459,000 optimal workforce, respectively, estimated by the team’s model). The gap is estimated to be greatest in low-income countries, where the current surgeon availability is 22,000 fewer than the model estimated optimal number of 28,000 surgeons. The current number of anaesthetists in low-income countries falls 11,000 below the model estimated demand of 13,000 anaesthetists.

In recognition of the rising global demand for cancer surgery, estimates were calculated for the optimal surgical and anaesthesia workforces needed in 2040. Extrapolating 2018 data, taking account of predicted future cancer incidence burden in each country, revealed that the surgical workforce will need to increase from 965,000 in 2018 to 1,416,000 (47% increase) in 2040. The anaesthetist workforce would need to rise from 459,000 in 2018 to 674,000 (47% increase) in 2040.

The greatest relative increase in optimal workforce requirements from 2018 to 2040 will occur in low-income countries, where surgeon numbers are required to rise from 28,210 to 58,219 by 2040 (106%). Anaesthetist numbers will also need to increase from 13,000 to 28,000 by 2040 (115%).

However, to match the current benchmark of high-income countries, the actual number of surgeons in low-income countries would need to increase almost 400% (increase from 6,000 to 28,000), and anaesthetists by nearly 550% (increase from 2,000 to 13,000), of their baseline values. This is because the current workforce in these countries is already substantially smaller than in high-income countries.

Dr. Sathira Perera, from the University of New South Wales, Australia, said: “Our analysis has revealed that, in relative terms, low-income countries will bear the brunt of increased future demand for cancer surgery, bringing with it a need to substantially increase numbers of surgeons and anaesthetists. These findings highlight a need to act quickly to ensure that increasing workforce requirements in low-income countries are adequately planned for. There needs to be an increased focus on the application of cost-effective models of care, along with government endorsement of scientific evidence to mobilise resources for expanding services.”

Estimates in the study relied on several assumptions. Predictions of future cancer rates were based on 2018 estimates, however, country-level changes—such as economic developments or altered capacity to screen for early diagnosis—could alter cancer incidence and therefore surgical demand and workforce requirements. Observed gaps in the workforce could also be narrower than the actual gaps in practice, as predictions were conservative because they only considered initial surgical encounters and did not account for any follow-up interactions.

Cancer surgery outcomes

The Article in The Lancet is an observational study exploring global variation in post-operative complications and deaths following surgery for three common cancers.

Deaths among gastric cancer patients were nearly four times higher in low/lower middle-income countries (33 deaths among 326 patients, 3.72 odds of death) than high-income countries (27 deaths among 702 patients).

Patients with colorectal cancer in low/lower middle-income countries were also more than four times more likely to die (63 deaths among 905 patients, 4.59 odds of death), compared with those in high-income countries (94 deaths among 4,142 patients). Those in upper middle-income countries were two times as likely to die (47 deaths among 1,102 patients, 2.06 odds of death) as patients in high-income countries.

No difference in 30-day mortality was seen following breast cancer surgery.

Similar rates of complications were observed in patients across all income groups, however those in low/lower middle-income countries were six times more likely to die within 30 days of a major complication (96 deaths among 133 patients, 6.15 odds of death), compared with patients in high-income countries (121 deaths among 693 patients). Patients in upper middle-countries were almost four times as likely to die (58 deaths among 151 patients, 3.89 odds of death) as those in high-income countries.

Patients in upper middle-income and low/lower middle-income countries tended to present with more advanced disease compared with those in high-income countries, however researchers found that cancer stage alone explained little of the variation in mortality or post-operative complications.

Between April 2018 and January 2019, researchers enrolled 15,958 patients from 428 hospitals in 82 countries undergoing surgery for breast, colorectal or gastric cancer. 57% of patients were from high-income countries (9,106 patients), with 17% from upper middle-income countries (2,721 patients), and 26% from low/lower middle-income countries (4,131 patients). 53% (8,406) of patients underwent surgery for breast cancer, 39% (6,215) for colorectal cancer, and 8% (1,337) for gastric cancer.

Assessing hospital facilities and practices across the different income groups revealed that hospitals in upper middle-income and low/lower middle-income countries were less likely to have post-operative care infrastructure (such as designated post-operative recovery areas and consistently available critical care facilities) and cancer care pathways (such as oncology services). Further analysis revealed that the absence of post-operative care infrastructure was associated with more deaths in low/lower middle-income countries (7 to 10 more deaths per 100 major complications) and upper middle-income countries (5 to 8 more deaths per 100 major complications).

Professor Ewen Harrison, of the University of Edinburgh, UK, said: “Our study is the first to provide in-depth data globally on complications and deaths in patients within 30 days of cancer surgery. The association between having post-operative care and lower mortality rates following major complications indicates a need to improve care systems to detect and intervene when complications occur. Increasing this capacity to rescue patients from complications could help reduce deaths following cancer surgery in low- and middle-income countries.

“High quality all-round surgical care requires appropriate recovery and ward space, a sufficient number of well-trained staff, the use of early warning systems, and ready access to imaging, operating theatre space, and critical care facilities. While in this study it wasn’t possible to assess cancer patients’ full healthcare journey, we did identify several parts of the surgical health system, as well as patient-level risk factors, which could warrant further study and intervention.”

Source: Read Full Article

California becomes first state to top 3 million virus cases

California becomes first state to top 3 million virus cases

California on Monday became the first state to record more than 3 million known coronavirus infections.

The grim milestone, as tallied by Johns Hopkins University, wasn’t entirely unexpected in a state with 40 million residents but its speed stunning. The state only reached 2 million reported cases on Dec. 24.

The first coronavirus case in California was confirmed last Jan. 25. It took 292 days to get to 1 million infections on Nov. 11 and 44 days to top 2 million.

California’s caseload is also far ahead of other large states. Texas had more than 2 million and Florida topped 1.5 million.

The state has recorded more than 33,600 deaths related to COVID-19.

A caseload surge that began last fall has strained hospitals and especially intensive care units as a percentage of the infected—typically estimated to be around 12% by public health officials—become sick enough weeks later to need medical care.

On average, California has seen about 500 deaths and 40,000 new cases daily for the past two weeks.

Officials warn that a recent slight downward trend in hospitalizations could reverse when the full impact of New Year’s Eve gathering transmissions is felt.

The state is placing its hopes on mass vaccinations to reduce the number of infections but there have been snags in the immunization drive. On Sunday, Dr. Erica S. Pan, the state epidemiologist, urged that providers stop using one lot of a Moderna vaccine because some people needed medical treatment for possible severe allergic reactions.

More than 330,000 doses from lot 41L20A arrived in California between Jan. 5 and Jan. 12 and were distributed to 287 providers, she said.

In Northern California, Stanislaus County health officials responded by announcing they wouldn’t be holding vaccination clinics until further notice.

“Out of an extreme abundance of caution and also recognizing the extremely limited supply of vaccine, we are recommending that providers use other available vaccine inventory” pending completion of an investigation by state officials, Moderna, the U.S. Centers for Disease Control and the federal Food and Drug Administration, Pan said in a statement.

Fewer than 10 people, who all received the vaccine at the same community site, needed medical attention over a 24-hour period, Pan said. No other similar clusters were found.

Pan did not specify the number of cases involved or where they occurred.

Six San Diego health care workers had allergic reactions to vaccines they received at a mass vaccination center on Jan. 14. The site was temporarily closed and is now using other vaccines, KTGV-TV reported.

Moderna in a statement said the company “is unaware of comparable adverse events from other vaccination centers which may have administered vaccines from the same lot.”

The CDC has said COVID-19 vaccines can cause side effects for a few days that include fever, chills, headache, swelling or tiredness, “which are normal signs that your body is building protection.”

However, severe reactions are extremely rare. Pan said in a vaccine similar to Moderna’s, the rate of anaphylaxis—in which an immune system reaction can block breathing and cause blood pressure to drop—was about 1 in 100,000.

The announcement came as California counties continue to plead for more COVID-19 vaccine as the state tries to tamp down its rate of infection, which has resulted in record numbers of hospitalizations and deaths.

California has shipped about about 3.2 million doses of the vaccine—which requires two doses for full immunization—to local health departments and health care systems, the state’s Department of Public Health reported Monday.

Only about 1.4 million of those doses, or around 40%, have been administered.

So far, the state has vaccinated fewer than 2,500 people per 100,000 residents, a rate that falls well below the national average, according to federal data.

Although Gov. Gavin Newsom announced last week that anyone age 65 and older would be eligible to start receiving the vaccine, Los Angeles County and some others have said they do not have enough doses to vaccinate that many people and are first concentrating on inoculating health care workers and the most vulnerable elderly living in care homes.

The death rate from COVID-19 in Los Angeles County—the nation’s most populous and an epicenter of the state pandemic—works out to about one person every six minutes.

On Sunday, the South Coast Air Quality Management District suspended some pollution-control limits on the number of cremations for at least 10 days in order to deal with a backlog of bodies at hospitals and funeral homes.

“The current rate of death is more than double that of pre-pandemic years,” the agency said.

Adding to concerns, California is experiencing new, possibly more transmissible forms of COVID-19.

The state health department announced Sunday that an L452R variant of the virus is increasingly showing up in genetic sequencing of COVID-19 test samples from several counties.

The variant was first identified last year in California and in other states and countries but has been identified more frequently since November and in several large outbreaks in Northern California’s Santa Clara County, the department said.

Overall, the variant has been found in at least a dozen counties. In some places, testing has found the variant in a quarter of the samples sequenced, said Dr. Charles Chiu, a virologist and professor of laboratory medicine at the University of California San Francisco.

However, not all test samples receive genetic sequencing to identify variants so its frequency wasn’t immediately clear.

Health officials said it was linked to a Christmas-time outbreak at Kaiser Permanente San Jose that infected at least 89 staff members and patients, killing a receptionist. The outbreak has been blamed on an employee who visited the hospital emergency room wearing an air-powered inflatable Christmas tree costume.

The variant is different from another mutation, B117, that was first reported in the United Kingdom and appears to spread much more easily, although it doesn’t appear to make people sicker.

Source: Read Full Article

EU to buy up to 300 million doses of Pfizer-BioNTech vaccine

The European Commission will sign a deal to secure up to 300 million doses of the experimental coronavirus vaccine developed by BioNTech and Pfizer.

Ursula von der Leyen, the president of the EU’s executive arm, said the commission will authorize the deal on Wednesday after “working tirelessly to secure doses of potential vaccines” in recent months.

“This is the most promising vaccine so far,” von der Leyen said. “Once this vaccine becomes available, our plan is to deploy it quickly, everywhere in Europe.”

Pfizer said Monday that early results from the vaccine suggests the shots may be a surprisingly robust 90% effective at preventing COVID-19.

The European Commission had already secured three other deals with pharmaceutical companies allowing its 27 member states to buy nearly one billion doses of a potential coronavirus vaccine.

“And more will come. Because we need to have a broad portfolio of vaccines based on different technologies,” von der Leyen said. “We have already started working with member states to prepare national vaccination campaigns. We are almost there. In the meantime, let us be prudent, and stay safe.”

The commission said once a vaccine is ready, member states should have access to it at the same time, and give priority to groups including healthcare workers and people over 60 years, as well as people with health conditions making them more vulnerable.

BioNTech said Tuesday that it and Pfizer have so far signed commercial supply agreements for 570 million doses in 2020 and 2021, with options to purchase an additional 600 million doses.


Source: Read Full Article

U.S Coronavirus Cases Top 9 MIllion

FRIDAY, Oct. 30, 2020 — Nine million coronavirus cases. That was the somber threshold the United States crossed on Thursday, and it was accompanied by another record-breaking number: 90,000 new daily cases.

Over the past week, the United States has recorded more than 500,000 new cases, The New York Times reported. That is an average of more than 77,000 cases a day. More total cases have been identified in the United States than in any other country, and nine states reported daily records on Thursday, the newspaper said.

Among them: More than 2,000 new coronavirus cases in Colorado; more than 6,400 new cases in Illinois; and more than 1,000 new cases in New Mexico.

“There is no way to sugarcoat it: We are facing an urgent crisis, and there is an imminent risk to you, your family members, your friends, your neighbors,” Gov. Tony Evers of Wisconsin said Thursday, the Times reported.

Evers’ state had been hard by coronavirus: More than 200 coronavirus deaths have been announced over the past week, and as case numbers have exploded, hospitals have strained.

But Wisconsin is not alone. The surge that started in the Upper Midwest and rural West has now spread far beyond, sending infection levels soaring in places like El Paso, Chicago and Rexburg, Idaho, according to the Times.

In the seven-day period ending Thursday, 24 states added more cases than in any other seven-day stretch of the pandemic, the newspaper said.

Daily reports of deaths from the virus still remain far below their spring peaks, averaging around 800 a day, but those have also started to climb, the Times reported.

The latest statistics offer little hope that the pandemic is easing.

Reports of new cases are increasing in 42 states, the Times said. Northeastern states, including New Jersey and Rhode Island, are seeing infection numbers rise after months of stability. In North Dakota, where more than 5 percent of the population has now tested positive — the biggest share of any state — reports of new cases continue to soar.

States lack money to distribute a COVID vaccine

Meanwhile, state health officials say they are frustrated about a lack of financial support from the federal government as they face orders to prepare to receive and distribute the first doses of a coronavirus vaccine by the unlikely target date of Nov. 15, the Washington Post reported. And these officials stress that they don’t have enough money to pay for the massive undertaking.

State officials say they have been planning distribution efforts even though no one knows which vaccine will be authorized, what special storage and handling may be required, and how many doses each state will receive.

Even so, the U.S. Centers for Disease Control and Prevention sent a letter this week asking states to provide by next Tuesday critical information, including a list of each jurisdiction’s top five sites capable of receiving and administering a vaccine that must be stored at extremely cold temperatures of minus-94 Fahrenheit, the Post reported. The letter refers to the vaccine only as Vaccine A, but industry and health officials say it is the Pfizer vaccine.

“We acknowledge that you are being asked to do unprecedented work,” wrote Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases, which is leading the CDC’s role in vaccine distribution. She added: “This is a new planning ask,” the Post reported.

State officials say they have been trying to raise the issue with federal officials but have received little response.

“It is absolutely ridiculous that the administration, after spending $10 billion for a Warp Speed effort to develop a vaccine, has no interest in a similar investment in a Warp Speed campaign to get the vaccine to every American as quickly as possible after it is approved,” Michael Fraser, executive director of the Association of State and Territorial Health Officials, told the Post.

“The now accelerated timeline underscores the need to address the issue of funding for state and territorial health agencies to make this all work,” Fraser said. “There are many other costs that have no clear way to be paid for at this point.”

States and territories have received $200 million from the CDC to do planning, the Post reported.

Recruiting and training workers for coronavirus vaccination campaigns will cost at least $3 billion. Another $1.2 billion will be needed for cold supply chain management, $1 billion for arranging additional vaccination sites and $500 million for data information system upgrades, the Post reported.

Fauci calls for national mask mandate

America’s leading infectious diseases expert on Wednesday called for a national mask mandate as coronavirus cases surged across the country.

After expressing regret that face masks haven’t been more widely adopted, Dr. Anthony Fauci said for the first time Wednesday that the United States needs a nationwide mask mandate to combat the rising tide of coronavirus infections, the Post reported.</p>

Until now, Fauci has been reluctant to back such a sweeping policy, telling reporters in September that a national mandate “probably would not work,” the Post reported. But in an interview with CNBC on Wednesday, Fauci said that he had hoped “we could pull together as a country” and recognize the importance of mask-wearing without the government getting involved, the Post reported.

When questioned whether it was time for a national mask mandate, Fauci said, “You know, yes. If we don’t get one, I would hope that the mayors and the governors do it locally.”

Earlier on Wednesday, Fauci was also asked about a potential mask mandate during a question-and-answer session hosted by the Journal of the American Medical Association. He stressed the key to avoiding future lockdowns was getting 90 percent or more of the population to wear masks, the <i>Post</i> reported.

Calling the prospect of a new round of stay-at-home measures “almost radioactive,” Fauci said that Americans would have to “at least do the fundamental, basic things” if they want to avoid additional shutdowns. “What we can’t have is this very inconsistent wearing that you see, where some states absolutely refuse to wear a mask,” he said.

Meanwhile, hospitals across America were struggling as the new coronavirus struck with a vengeance in parts of the country that had been spared the worst in the early days of the pandemic.

The number of people hospitalized with COVID-19 has climbed an estimated 46 percent in the past month, straining the capacity of regional health care systems to respond to overwhelming demand, the Times reported.

Twenty-six states are at or near record numbers for new infections, the newspaper reported. More than 500,000 new cases have been announced in the past week, and no states are seeing sustained declines in case numbers.

The situation is grim in the Texas town of El Paso: The number of people hospitalized with COVID-19 has more than tripled over the past three weeks, and doctors at University Medical Center there have started airlifting some patients to hospitals as far away as San Antonio while treating others in a field hospital in a nearby parking lot, the Times reported.

States, cities and towns are responding to this latest coronavirus surge with new restrictions that range from a nightly business curfew in Newark, N.J., to a two-week stay-at-home order in El Paso to a halt to indoor dining in Chicago, the Times reported.

COVID-19 continues to spread around the globe

By Friday, the U.S. coronavirus case count passed 9 million while the death toll passed 228,700, according to a Times tally.

According to the same tally, the top five states in coronavirus cases as of Friday were: Texas with over 938,600; California with nearly 927,000; Florida with over 794,600; New York with nearly 508,000; and Illinois with more than 401,600.

Curbing the spread of the coronavirus in the rest of the world remains challenging.

Europe passed 10 million cases on Friday as some countries went into new lockdowns, the AP reported.

Things are no better in India, where the coronavirus case count has passed 8 million, a Johns Hopkins tally showed.

More than 121,000 coronavirus patients have died in India, according to the Hopkins tally, but when measured as a proportion of the population, the country has had far fewer deaths than many others. Doctors say this reflects India’s younger and leaner population.

Still, the country’s public health system is severely strained, and some sick patients cannot find hospital beds, the Times said. Only the United States has more coronavirus cases.

Meanwhile, Brazil neared 5.5 million cases and had nearly 159,0000 deaths as of Friday, the Hopkins tally showed.

Cases are also spiking in Russia: The country’s coronavirus case count has neared 1.6 million. As of Friday, the reported death toll in Russia was over 27,400, the Hopkins tally showed.

Worldwide, the number of reported infections passed 45.1 million on Friday, with nearly 1.2 million deaths, according to the Hopkins tally.

More information

The U.S. Centers for Disease Control and Prevention has more on the new coronavirus.

SOURCES: Washington Post; The New York Times; Associated Press

Source: Read Full Article

Coronavirus cases surge past 40 million infections worldwide

Concerning coronavirus trend? US sees big spike in new cases

Fox News correspondent Jonathan Serrie has the latest from Atlanta on ‘Special Report’

LONDON – The number of confirmed COVID-19 cases throughout the world has surpassed 40 million, but experts say that is only the tip of the iceberg when it comes to the true impact of the pandemic.

The milestone was hit Monday morning, according to Johns Hopkins University, which collates reports from around the world.

The actual worldwide tally of COVID-19 cases is likely to be far higher, as testing has been variable, many people have had no symptoms and some governments have concealed the true number of cases. To date, more than 1.1 million confirmed virus deaths have been reported, although experts also believe that number is an undercount.

CORONAVIRUS: WHAT YOU NEED TO KNOW

The U.S., India, and Brazil are reporting by far the highest numbers of cases — 8.1 million, 7.5 million, and 5.2 million respectively — although the global increase in recent weeks has been driven by a surge in Europe, which has seen more than 240,000 confirmed virus deaths in the pandemic so far.

Will a COVID-19 vaccine be ready for emergency use by November?

Dr. Marc Siegel, Fox News medical contributor reacts to Dr. Fauci’s recent comments on a potential COVID-19 surge and Pfizer’s COVID-19 vaccine&nbsp;
production timeline.

Last week, the World Health Organization said Europe had reported a record weekly high of nearly 700,000 cases and said the region was responsible for about a third of cases globally. Britain, France, Russia and Spain account for about half of all new cases in the region, and countries like Belgium and the Czech Republic are facing more intense outbreaks now than they did in the spring.

WHO said the new measures being taken across Europe are “absolutely essential” in stopping COVID-19 from overwhelming its hospitals. Those include new requirements on mask-wearing in Italy and Switzerland, closing schools in Northern Ireland and the Czech Republic, closing restaurants and bars in Belgium, implementing a 9 p.m. curfew in France and having targeted limited lockdowns in parts of the U.K.

The agency said several European cities could soon see their intensive care units overwhelmed and warned that governments and citizens should take all necessary measures to slow the spread of the virus, including bolstering testing and contact tracing, wearing face masks, and following social distancing measures.

NYC BANQUET HALL CITED FOR HUGE PARTY THAT VIOLATED CORONAVIRUS RESTRICTIONS

WHO has previously estimated about 1 in 10 of the world's population — about 780 million people — have been infected with COVID-19, more than 20 times the official number of cases. That suggests the vast majority of the world's population is still susceptible to the virus.

Some researchers have argued that allowing COVID-19 to spread in populations that are not obviously vulnerable will help build up herd immunity and is a more realistic way to stop the pandemic instead of the restrictive lockdowns that have proved economically devastating.

A man walks past anti-lockdown graffiti in Manchester, England, Monday, Oct. 19, 2020 as the row over Greater Manchester region’s coronavirus status continues. Britain’s government says discussions about implementing stricter restrictions in Greater Manchester must be completed Monday because the public health threat caused by rising COVID-19 infections is serious and getting worse. (Peter Byrne/PA via AP)

But WHO Director-General Tedros Adhanom Ghebreyesus has warned against the belief that herd immunity might be a viable strategy to pursue, saying this kind of protection needs to be achieved by vaccination, not by deliberately exposing people to a potentially fatal disease.

“Allowing a dangerous virus that we don’t fully understand to run free is simply unethical,” Tedros said last week.

The U.N. health agency said it hopes there might be enough data to determine if any of the COVID-19 vaccines now being tested are effective by the end of the year. But it warned that first-generation vaccines are unlikely to provide complete protection and that it could take at least two years to bring the pandemic under control.

Source: Read Full Article