Dr Sathira Perera

Dr. Sathira Perera is currently a UNSW Scientia PhD Scholar. He graduated in Medicine, and later got specialised in public health and health economics with master’s degrees for both specialities. He has been engaged in the fields of clinical medicine, research, academia and policy making at different levels.

Abstract

Evidence based predictions for the demand for cancer surgery in Australia

Sathira Perera  Michael Barton  Susannah Jacob

Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Ingham Institute for Applied Medical Research, University of New South Wales , Liverpool, NSW, Australia

Estimating the optimum rate for utilization of surgery in the management of cancer, helps to identify any existing treatment gaps, estimate the survival and economic impacts of such gaps and to predict the population level demand for cancer surgery. A population-based benchmark rate for optimum surgical utilization has not been estimated before in Australia or elsewhere.

Developing models to estimate the optimum cancer surgical utilization rates, required complexity and the demand for cancer surgery in Australia.

Latest clinical guidelines were examined, and decision trees were created using the Tree Age Pro software to map treatment pathways for individual cancers. Epidemiological data in the trees were sourced from Australia and other settings and the optimum surgical utilization rate for each cancer was calculated. These rates and the cancer incidence data were then used to estimate the present and future demand for cancer specific surgery in Australia.

The model calculated that surgery is indicated in 58% (95%CI 57%-59%) of newly diagnosed cancer patients in Australia, at least once during the course of their treatment. The optimum surgical utilization rate for breast cancer was 0.97 (95% CI 0.96 to 0.98), whiles the rates for colon cancer 0.86 (95% CI 0.85 to 0.97), rectal cancer 0.89 (95% CI 0.88 to 0.99), prostate 0.22 (95% CI 0.17 to 0.24) and lung cancer was 0.33 (95% CI 0.31 to 0.34).   The surgical complexity grade V accounted for the highest estimated surgical volume of 34%. The procedures under this category included procedures such as radical prostatectomy, mastectomy, pneumonectomy, lobectomy, cystectomy, nephrectomy, resection of brain cancer, abdominoperineal resection and colectomy.  

Gastro-intestinal cancers accounted for the highest estimated number (21414) of surgical procedures required in year 2020, followed by skin cancer (17219), breast cancer (16694) and genitourinary cancer (12215).  The total annual number of estimated surgical procedures to be performed under optimal circumstances by year 2020 will be 85030. This is expected to increase to more than 150000 if the current incidence rates of cancer remain stable during the next couple of decades.

These numbers provide useful insights for planning the future investment required for funding cancer surgical care. It also produces evidence based numerical inputs on the cancer surgical burden required to plan the future human resource requirements for cancer surgery in Australia.