The number of patients requiring first-line chemotherapy is expected to increase by more than 50% from 2018 to 2040, and in order to deliver optimal treatment, a significant increase in the chemotherapy workforce is needed.
Between 2018 and 2040, the number of patients requiring first-line chemotherapy globally each year will increase 53% from 9.8 million to 15 million, if all patients are treated according to evidence-based guidelines, according to a new study.
In 2018, there were approximately 17 million new cases of cancer and it’s estimated that in 2040, the number of new cases will increase to 26 million, most of which will occur in low- or middle-income countries. According to the study, by 2040, two-thirds (67%) of patients requiring chemotherapy will live in these countries, and 75% of the additional 5.2 million needing the treatment by 2040 will be from these countries.
The increase in chemotherapy demand will largely be a result of population growth and projected changes in the distribution of cancer types by country, according to the researchers.
The study, which is the first to estimate global demands for chemotherapy based on evidence-based guidelines, relied on global incidences of 29 of the most common cancers in 183 countries obtained from GLOBOCAN 2018, which includes projections of incidences every 5 years from 2020 to 2040. Optimal chemotherapy utilization from evidence-based guidelines was applied to the data to determine the number of new patients requiring chemotherapy in 2040.
In response to increased demand for chemotherapy, the workforce will also need to expand. In 2018, there were approximately 65,000 cancer physicians who administered chemotherapy for patients, and the researchers estimate that nearly 100,000 physicians will be required in 2040, 67.2% of which will be required in low- and middle-income countries.
“The rising global cancer burden is undoubtedly one of the major health crises today,” said Brooke Wilson, MSc, University of New South Wales and the Collaboration for Cancer Outcomes, Research, and Evaluation at the Ingham Institute for Applied Medical Research, in a statement. “Strategies are urgently needed to equip the global workforce to enable safe treatment of current and future patients.”
The most common cancers indicating chemotherapy treatment in 2040 will be lung cancer (16%), breast cancer (12.7%), and colorectal cancer (11.1%). These 3 cancers will also account for the largest absolute increases in the number of patients needing the treatment; however, treatment demand for gallbladder cancer and bladder cancer is expected to increase by the largest relative amount.
Looking at optimal chemotherapy utilization, the researchers found varying rates, which they noted was not significantly associated with national income level. In 2040, optimal utilization is expected to be 57%, with rates being highest in upper—middle-income countries (60%) and lowest in high-income countries (55%).
“The calculated chemotherapy utilization provides an estimate of demand, but actual utilization is often far lower than expected, even in high-income countries,” explained the researchers. For example, in the Netherlands, estimated adjuvant chemotherapy utilization for stage 3 colon cancer was 58% in 2006, while the estimated optimal rate was 89%.
Utilization also differs by patient demographics. For patients with stage 2 and 3 rectal cancer and stage 3 colon cancer in the United States, utilization varied from 88% for those younger than aged 55 years to 11% for those older than 85 years.
Gaps between optimal utilization and actual utilization might be a result of several factors, including patients’ or physicians’ preferences for treatment, treatment expenses, patient fitness, cultural beliefs, and lack of access, according to the researchers.
Wilson B, Jacob S, Yap M, Ferlay J, Bray F, Barton M. Estimates of global chemotherapy demands and corresponding physician workforce requirements for 2018 and 2040: a population-based study [published online May 8, 2019]. Lancet. doi: 10.1016/ S1470-2045(19)30163-9.