Chemo demand to increase 50% by 2040

The number of chemotherapy patients will increase by more than 50% by 2040, and will require a massive increase in the number of health practitioners to support them.

A new modelling study published in The Lancet Oncology has found that between 2018 and 2040, the number of patients requiring first-line chemotherapy treatment each year is likely to rise from 9.8 million to 15 million (53%) globally.

By 2040, 67% of patients requiring chemotherapy will reside in low- or middle-income countries. Of the additional 5.2 million people needing treatment by 2040, an estimated 75% will reside in these countries.

To respond to rising demand globally, the study estimates the number of health practitioners needed in 2018 and 2040 to provide chemotherapy to all patients who would benefit from it (the actual number of practising cancer physicians worldwide is unknown). Their results show that workforce requirements to deliver optimal chemotherapy will increase from approximately 65,000 cancer physicians in 2018 to 100,000 in 2040.

“The rising global cancer burden is undoubtedly one of the major health crises of today. Strategies are urgently needed to equip the global health workforce to enable safe treatment of current and future patients,” says Dr Brooke Wilson, study first author from the University of New South Wales and the Collaboration for Cancer Outcomes, Research and Evaluation at the Ingham Institute for Applied Medial Research.

“Countries and institutions should use our data to estimate their future cancer physician workforce requirements and chemotherapy needs and plan national, regional, and global strategies to ensure all those who need it will have access to chemotherapy treatment.”

The authors used best-practice guidelines, patient characteristics and cancer-stage data from the USA and Australia to calculate the proportion of newly diagnosed cases of cancer that would benefit from chemotherapy. They applied these rates to international estimates of global incidences of adult and paediatric cancer from 2018 up to 2040 (GLOBOCAN) to provide estimates of global chemotherapy demand.

In 2040, the most common cancers needing chemotherapy will be lung (16.4%, 2.5 million), breast (12.7%, 1.9 million) and colorectal cancer (11.1%, 1.7 million), and the greatest absolute increases in new cases will occur for these same three types of cancer.

The authors predict the required workforce to optimally deliver this chemotherapy demand will rise from 65,000 in 2018 to 100,000 in 2040, assuming each doctor saw 150 new chemotherapy patients (a safe workload). However, the actual workload of cancer physicians varies significantly worldwide, so the authors produced additional estimates based on 100 or 300 new patients per year needing chemotherapy. Therefore, estimates for the required workforce ranged from 32,600 to 97,800 physicians in 2018 and 50,000 to 150,000 in 2040.

The authors acknowledge that actual chemotherapy use is generally lower than the optimal use based on guidelines for a variety of reasons, including patients' and clinicians' treatment preferences, expenses, cultural acceptance, lack of access to services, and regional variations in practice. In addition, this difference is even greater in low- and middle-income countries, as many individuals cannot afford the costs of chemotherapy and are without health insurance. There are also other barriers, including scarcity of drugs, infrastructure for delivery, supportive pathology and radiotherapy services, and trained workforce.

The authors note some limitations of their study. Cancer-stage data from the US and Australia was applied globally, but cancer is often diagnosed at a later stage of disease in low- and middle-income countries. This may increase the demand for chemotherapy by 7–24% compared to the baseline predictions, according to the sensitivity analysis performed in this study.

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