LACK OF ONCOLOGISTS IN MANY PARTS OF THE WORLD

Cancer is the second leading cause of death worldwide, but access to treatment and mortality rate varies widely. Importantly, in many regions of the world, there is a profound lack of oncologists to deliver care, and in some extreme cases, no oncologists at all.

A new survey, published in the Journal of Global Oncology, examined the number of clinical oncologists in 93 countries and identified significant disparities in the availability of clinical oncologists.

For example, 8 countries reported that there were no clinical oncologists at all who could care for patients with cancer. In 27 countries, there was also an extreme shortage of oncologists, with a ratio of 1 oncologist per more than 1000 incident cancers.

Most of the countries facing a critical shortage of oncologists are in Africa, which also has a high mortality rate from cancer. Of the 26 nations reporting a mortality-to-incidence ratio higher than 70%, 21 are in Africa. No African countries reported a mortality-to-incidence ratio of less than 50%.

"The economic status of a country and its social development status correlate closely with the mortality-to-incidence ratio and the availability of clinical oncologists," writes study author Aju Mathew, MD, MPhil, from the University of Kentucky, Lexington, and Kerala Cancer Care, Kochi, India.

Cancer incidence and mortality are rising in many parts of the world, where access to treatment and healthcare professionals are more limited. Even in the United States, where the cancer mortality rates have been declining, there are noted disparities.

Survey of 93 Countries 

While the shortages of oncologists throughout the world are well known, the magnitude of the situation has not been well described in the literature, Mathew points out.  The objective of this study was to conduct a comprehensive global survey of the clinical oncology workforce.

Data on the number of clinical oncologists in 93 countries were obtained from 30 references in the literature. Estimates on cancer incidence and mortality rates at the country level were obtained by using the GLOBOCAN model from 2012, produced by the International Agency for Research on Cancer. The mortality-to-incidence ratio was computed from the data supplied by the GLOBOCAN 2012 database.

In addition, the social development of a country was defined by the Sociodemographic Index (SDI) by using criteria such as education, income, and fertility, and countries were classified as having a low, low-middle, middle, high-middle, or high SDI.

Mortality-to-Incidence Ratio

The survey included 32 countries in Africa, 21 from Asia and Australia, 31 from Europe, and 9 from North and South America. Twenty countries were categorized as low income, 19 as low SDI; 2 were categorized as low economic income but with low-middle SDI (Zimbabwe and Nepal); and 2 other countries were categorized as low SDI but also lower-middle income according to use of the World Bank definition (Cote d'Ivoire and Mauritania).

The mortality-to-incidence ratio was greater than 70% in 26 countries (28%) and was less than 50% in 23 (25%) countries. In Asia, the mortality-to-incidence ratio was greater than 70% in 5 countries (26%) and less than 50% in 3 (16%), while none of the countries in Europe or the Americas had a mortality-to-incidence ratio exceeding 70%. The mortality-to-incidence ratio was greater than 50% in 13 European countries (42%) and 7 (100%) in South America. By far, the continent with the highest mortality-to-incidence ratio was Africa.

Ratio of Oncologists to Patients

When looking at the ratio of clinical oncologists to newly diagnosed patients, the global pattern was similar to that of the mortality-to-incidence ratio. In only 22 countries (24%) would an oncologist care for fewer than 150 patients with newly diagnosed cancer, while in 39 countries (42%), oncologists would be caring for more than 500 patients; 26 of these countries were in Africa (81%), 9 in Asia (47%), 2 in Europe (6%), and 2 in South America (29%).

There was an extreme shortage of clinical oncologists, with 1 oncologist per 1000+ incident cancers in 25 African countries (78%) and 2 Asian countries (11%).

Mathew emphasizes that training programs must be instituted in regions with an extreme shortage of clinical oncologists, and it is urgent to design measures that will address challenges within these regions. One suggestion is nontraditional approaches, such as training primary care providers and nurses, and that instead of sending doctors and nurses from low-income countries abroad for training, these funds can be used to enhance regional collaborations.

While increasing the availability of clinical oncologists may not improve the quality of cancer care, he notes that "easier access to a trained health care professional will positively influence the society."