Cancer Surgery Research as a Lifeline

How important is cancer surgery research for a developing country?

By Carmela Caballero, MD

April 2021

Being a surgeon trained in the Philippines and now working in an international cancer research organisation in Belgium, what keeps me up at night is the paucity of surgical research from my home country. A PubMed search for "cancer research" and Philippines between 2000 and 2021 per disease type (breast, colon, lung, head and neck) generated dismal results. Breast cancer in the Philippines retrieved around 40 studies in a span of 20 years. Local scientific journals yielded a good number of retrospective studies, consensus guidelines and case reports oriented in cancer surgery but considering the incidence of cancer or the volume of surgical cases in the country, the results are disproportionately low.

Cancer surgery research in the Philippine setting

What is at stake? The 2018 GLOBOCAN report showed that from a population of 100 million, there were 140,000 new cancer cases and more than 80,000 cancer deaths in the Philippines (Ferlay, et al., 2018). By 2040, there will be 40,000 new cases of breast cancer, overtaking lung cancer incidence. Urgent action is needed. In a country like the Philippines with are a relatively young population, these statistics may include a younger age bracket in contrast to its aging western counterparts, age groups that would normally contribute to a productive economy.

The Philippine surgical training program has an existing system to ensure generation of new research. Each eligible surgeon must produce a research approved by the institutional regulatory board prior to his or her licensure. However, a structured research curriculum and experts in the conduct and development of research methodology are sorely lacking or not given due recognition and support (Limson et al., 1999). A critical shift in perspective is needed to recognise the value of research for a developing country. It can no longer remain as a mere academic requirement or something that will just facilitate career advancement. In the era of precision medicine and amidst an increasing burden of cancer, surgeons can no longer remain as "skillful technicians" and surgical research cannot be a “comic opera” (Evrard, et al., 2016).

But there are reasons to be hopeful. During the last five years, important achievements have been made: the establishment of the Philippine Cancer Commission, enactment of the Republic Act 11215 institutionalising a National Integrated Cancer Control Program (NICCA) and two successful national Cancer Summits for specialists and lay public led by the Philippine College of Surgeons. These are giant leaps in the right direction but a lot of work is still needed. Research will need to fuel the ambitious goals of these national initiatives.

Improving the infrastructure to support cancer research

What specific steps can be taken to increase and improve the cancer surgery research output from the Philippines? A more rigorous and comprehensive research curriculum needs to be integrated within the current surgical training programs (Are et al., 2016; Are et al., 2018; Suliburk et al., 2008). Expertise from multi-disciplinary specialists already engaged in research, biostatisticians, data management and regulatory experts will be crucial to establishing functional research units. Young surgeons will need role models within and beyond their specialty. Exposure to molecular biology, bioinformatics, information technology and other oncologic specialties will broaden their understanding of cancer (O’Sullivan, 2010). Local and international educational opportunities that encourage critical thinking, innovation and discovery across these fields must be encouraged and funded by surgical societies. The optimal use and data mining of the national cancer registries, careful assessment of surgical outcomes and impact of quality-improvement pathways for patient care are complex but highly relevant research initiatives that can be achieved by young surgeons in the current Philippine setting.

A crucial element for research is funding and this is even more difficult in the surgical field. Research activities and publications are the leverage of institutions to attract grants and international recognition. Until a hospital produces high quality research, it will have limited chances of being recognised by funding bodies especially international ones. Hence, it will be important for surgical training departments to provide incentives to its senior and junior members to be engaged in collaborative research and build a portfolio of their scientific activities as a way to attract funding through local or international grants, donations or clinical trials.

Conclusion

Finally, cancer care is multidisciplinary. Surgeons will need to facilitate strong collaborations across different cancer specialties. Today, we have more ways to communicate and work together, albeit remotely. Multi-disciplinary collaborations are crucial to improving patient care and generating new research ideas. Cancer research can reduce morbidity and mortality, improve patient’s quality of life, generate healthcare savings and attract funding. In the battle against cancer, research is the surgeon’s compass. Most of all, it is our patient’s lifeline.

Conflicts of interest:

The author does not have any conflict of interest to disclose.

References:

Are C, Berman RS, Wyld L, Cummings C, Lecoq C, Audisio RA (2016). Global Curriculum in Surgical Oncology. Ann Surg Oncol. 23, 1782-95.

Are C, Yanala U, Malhotra G, et al. (2018). Global curriculum in research literacy for the surgical oncologist. Eur J Surg Oncol. 44, 31-42.

Evrard S, Audisio R, Poston G, et al. From a comic opera to surcare an open letter to whom clinical research in surgery is a concern: Announcing the launch of surcare. (2016). Ann Surg. 264, 911-2.

Ferlay J, Colombet M, Soerjomataram I, et al. Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods. (2019). Int J Cancer. 144, 1941-53.

Limson AA, Danguilan JLJ, Gutierrez RR, De Jesus RS, Crisostomo AC, Roxas AM. (1999). Surgery in the Philippines. Arch Surg. 134, 323-7.

O’Sullivan GC. (2010). Advancing surgical research in a sea of complexity. Ann Surg. 252, 711-4

Suliburk JW, Kao LS, Kozar RA, Mercer DW. (2008) Training future surgical scientists: realities and recommendations. Ann Surg. 247, 741-9.