Estimating the impact of scaling up workforce personnel on global cancer mortality from 2030 to 2050: a simulation-based analysis of 17 cancers and 18 personnel types.

Abstract

The global burden of cancer continues to rise, disproportionately affecting low-income and middle-income countries, where cancer workforce shortages are especially acute and contribute to poor outcomes. In this analysis, we estimate the effect on cancer mortality of scaling up specific workforce personnel types in order to provide global, regional, and country-specific guidance to inform cancer workforce policy. Using the Global Cancer Workforce microsimulation model, which accounts for demographic, epidemiological, and health system factors related to cancer incidence and survival, we modelled the projected effect of scaling up 18 specific workforce personnel types on total cancer mortality (diagnosed and undiagnosed) from 17 cancers (oral, nasopharynx, oesophagus, stomach, colon, rectum, anus, liver, pancreas, lung, skin melanoma, breast, cervix uteri, ovary, prostate, bladder, and brain and CNS) in 200 countries and territories from 2030 to 2050. Workforce density (per 100 000 population) of each workforce personnel type was modelled based on estimates from various sources (including WHO Global Health Workforce Statistics, the IMAGINE database, and previous Lancet Commissions). Expert opinion surveys, with responses from 86 experts in 16 countries, informed the involvement of workforce personnel in specific model events. We also modelled scale-up of workforce by cadre (ie, teams of personnel that work together in a particular specialty) and level of training (ie, years of education). Substantial disparities in cancer workforce were projected to persist in 2050, with especially large workforce shortages in Africa. Among single personnel types, scaling up surgeons was projected to yield the largest reduction in global cancer mortality (3·64% [95% uncertainty interval 2·68-4·66]), especially in Africa, Asia, and Oceania, but with considerable heterogeneity by country. Among workforce cadres, scaling up diagnostic and imaging personnel was projected to yield the greatest benefit (global cancer mortality reduction of 7·61% [5·23-9·88]), with some heterogeneity by country. Comprehensive scale-up of all workforce levels was projected to reduce cancer mortality by over 50% in 55 countries, most notably in Africa, central America, and southern Asia. Investments to strengthen the cancer workforce will be essential to reduce global cancer mortality and improve timely diagnosis and survival. Strategic scale-up of personnel, particularly in diagnostics, alongside innovative strategies such as digital health solutions and role delegation, could result in substantial improvements in cancer outcomes. Policy makers should prioritise data-driven workforce planning as a crucial component of comprehensive cancer control strategies. American Cancer Society and Breast Cancer Research Foundation.