The State of Research and Development in Global Cancer Surgery
Arnie D. Purushotham, MD, Grant Lewison, PhD and Richard Sullivan, MD, PhD
Surgery is the main modality of control and cure for solid cancer in developed as well as low-middle income countries (LMIC) and is the only modality in a large proportion of cases globally. Research and development in surgical oncology are essential for improving patient outcomes. With the burden of chronic disease (including cancer) shifting to LMIC, surgery along with radiotherapy will constitute the backbone of cancer management for the majority of patients with olid cancer.1 There is no high quality intelligence available for the research community or policymakers to monitor existing trends in cancer surgical research, guide decision-making and support the cre- ation of new initiatives. Indeed, in comparison to other modalities such as medicines there is a serious lack of public policy discussion in cancer surgery. Furthermore, cancer surgery is almost absent from any World Health Organization national cancer control policy docu- ments and, unlike radiotherapy with the International Atomic Energy Agency ImPACT programme, there are few supranational champions. What data exist suggests that at national2 and supranational3 levels, public sector support for cancer surgery research and development (R&D) is low. If the state of cancer surgery R&D is “fragile” then this has serious implications for patient outcomes and suggests new policy approaches are needed.
The aim of this study was to perform an analysis of global cancer surgery R&D trends over the last 10 years (specifically 21 countries that constitute 90% activity) to determine the health of this domain. A powerful objective method, scientometrics, was used to interrogate cancer surgery R&D trends.4 In doing so we make a dis- tinction between academic surgery—R&D aimed at the evolution of surgical techniques (the trimuvirate of surgery-imaging-pathology), upon which this work focuses, as opposed to the academic surgeon— who can be active in R&D across a wide range of nonsurgical disciplines, such as fundamental biology.