Medical oncology future plan of the Spanish Society of Medical Oncology: challenges and future needs of the Spanish oncologists

[Experiences in human resources planning for health: The case of physicians. Data and models. SESPAS Report 2024]

Virtually all developed countries conduct physician planning exercises. We can learn from successful experiences. The modeling and projection of supply is technically complex, but it is a technical matter, whereas the assessment of demand or need, and therefore the outcome in terms of deficit or surplus, requires standards, usually in population ratios, which are based on expert judgments and belong to the normative universe. One type of technical problem insufficiently solved is that of converting "heads" into full time equivalents. Fortunately, progress is being made in the right direction. We need more and better information, in particular the State Register of Health Professionals, but even with the limitations of the data, it is necessary to plan. The Ministry of Health, the Autonomous Regions and other professional and union organizations regularly carry out planning exercises. We have high rates of physicians and graduates, and low rates of nurses, a growing number of physicians in both public and private practice, and short-term deficits in some specialties, particularly family medicine, which urgently needs specific incentives to stimulate vocations. The numbers tell only part of the story. The imbalances in the educational and labor markets are not resolved by creating vacancies, but rather by reforming the regulatory framework, incentive systems and public management slack to compete with the private sector in attracting and retaining talent.

Medical oncology workload, workforce census, and needs in Spain: two nationwide studies by the Spanish Society of medical oncology

PURPOSE

Growing complexity and demand for cancer care entail increased challenges for Medical Oncology (MO). The Spanish Society of Medical Oncology (SEOM) has promoted studies to provide updated data to estimate the need for medical oncologists in 2040 and to analyse current professional standing of young medical oncologists.

METHODS

Two national, online surveys were conducted. The first (2021) targeted 146 Heads of MO Departments, and the second (2022), 775 young medical oncologists who had completed their MO residency between 2014 and 2021. Participants were contacted individually, and data were processed anonymously.

RESULTS

Participation rates reached 78.8% and 48.8%, respectively. The updated data suggest that 87-110 new medical oncologist full-time equivalents (FTEs) should be recruited each year to achieve an optimal ratio of 110-130 new cases per medical oncologist FTE by 2040. The professional standing analysis reveals that 9.1% of medical oncologists trained in Spain do not work in clinical care in the country, with tremendous employment instability (only 15.2% have a permanent contract). A high percentage of young medical oncologists have contemplated career paths other than clinical care (64.5%) or working in other countries (51.7%).

CONCLUSIONS

Optimal ratios of medical oncologists must be achieved to tackle the evolution of MO workloads and challenges in comprehensive cancer care. However, the incorporation and permanence of medical oncologists in the national healthcare system in Spain could be compromised by their current sub-optimal professional standing.

Geographic Distribution of Cancer Care Providers in the Philippines

PURPOSE

In the Philippines, a lower middle-income country in Southeast Asia, 6 of 10 Filipinos die without seeing a doctor. To ensure universal access to cancer care, providers must be equitably distributed. Therefore, we evaluated the distribution of oncologists across all 17 regions in the Philippines.

METHODS

We gathered data from the official websites of national medical societies on their members' regional area of practice: Philippine Society of Medical Oncology, Philippine Radiation Oncology Society, Surgical Oncology Society of the Philippines, Society of Gynecologic Oncologists of the Philippines, and Philippine Society of Hospice and Palliative Medicine. We compared this with the regional census to determine the number of board-certified oncologists per 100,000 Filipinos.

RESULTS

For a population of almost 110 million, the Philippines has a total of 348 medical oncologists, 164 surgical oncologists, 99 radiation oncologists, 142 gynecologic oncologists, and 35 hospice and palliative medicine (HPM) specialists. This translates to 0.32 medical oncologists, 0.15 surgical oncologists, 0.09 radiation oncologists, 0.13 gynecologic oncologists, and 0.03 HPM specialists for every 100,000 Filipinos. The number of oncologists is highest in the National Capital Region in Luzon and lowest in the Bangsamoro Autonomous Region in Muslim Mindanao. All regions have at least one medical and gynecologic oncologist. Two regions (12%) have no surgical oncologists, five regions (29%) have no radiation oncologists, and eight regions (47%) have no HPM specialists.

CONCLUSION

Efforts are needed to increase the number of oncologists and improve equity in their distribution to ensure universal access to cancer care in the Philippines.

Distribution of the workforce involved in cancer care: a systematic review of the literature

Background

A skilled health workforce is instrumental for the delivery of multidisciplinary cancer care and in turn a critical component of the health systems. There is, however, a paucity of data on the vast inequalities in cancer workforce distribution, globally. The aim of this study is to describe the global distribution and density of the health care workforce involved in multidisciplinary cancer management.

Methods

We carried out a systematic review of the literature to determine ratios of health workers in each occupation involved in cancer care per 100 000 population and per 100 cancer patients (PROSPERO: protocol CRD42018095414).

Results

We identified 33 eligible papers; a majority were cross-sectional surveys (n = 16). The analysis of the ratios of health providers per population and per patients revealed deep gaps across the income areas, with gradients of workforce density, highest in high-income countries versus low-income areas. Benchmark estimates of optimal workforce availability were provided in a secondary research analysis: mainly high-income countries reported workforce capacities closer to benchmark estimates. A paucity of literature was defined for critical health providers, including for pediatric oncology, surgical oncology, and cancer nurses.

Conclusion

The availability and distribution of the cancer workforce is heterogeneous, and wide gaps are described worldwide. This is the first systematic review on this topic. These results can inform policy formulation and modelling for capacity building and scaleup.

•

Workforce is an essential component of the health systems.

•

Stark inequalities are reported for the distribution of health workforce worldwide, but data are limited.

•

We aimed at portraying the first global figure of the comprehensive cancer workforce for cancer management.

•

Inequalities in density and distribution of the workforce regard all the key health personnel involved in cancer management.

•

These data will inform the development of evidence-informed policies for the workforce in low- and middle-income countries.

Tracking the Workforce 2020-2030: Making the Case for a Cancer Workforce Registry

Existing literature has described the projected increase in cancer incidence and the associated deficiencies in the cancer workforce. However, there is currently a lack of research into the necessary policy and planning steps that can be taken to mitigate this issue. Herein, we review current literature in this space and highlight the importance of implementing oncology workforce registries. We propose the establishment of cancer workforce registries using the WHO Minimum Data Set for Health Workforce Registry by adapting the data set to suit the multidisciplinary nature of the cancer workforce. The cancer workforce registry will track the trends of the workforce, so that evidence can drive decisions at the policy level. The oncology community needs to develop and optimize methods to collect information for these registries. National cancer societies are likely to continue to lead such efforts, but ministries of health, licensing bodies, and academic institutions should contribute and collaborate.

Gender influence on work satisfaction and leadership for medical oncologists: a survey of the Spanish Society of Medical Oncology (SEOM)

Background

Women represent an increasing proportion of the oncology workforce; however, globally this does not translate into leadership roles, reflecting disparities in career opportunities between men and women. The Spanish Society of Medical Oncology (SEOM) undertook a survey to investigate gender disparity in the Spanish oncology context.

Design

An online survey was made available to SEOM medical oncologists between February and May 2019. It included demographics, professional context and achievements, parenthood and family conciliation issues, workplace gender bias, and approaches to address disparities.

Results

Of the 316 eligible respondents, 71.5% were women, 59.5% were aged 45 or younger, and 66.1% had children. Among women, 12.4% were division or unit heads, compared with 45.5% of men, with most women (74.3%) being attending medical oncologists, compared with 45.5% of men. More males were professors (34.4% versus 14.2% of females), had a PhD (46.7% versus 28.8%), and/or had led clinical research groups (41.1% versus 9.7%). Spending time overseas after completing a residency was also more common for men than women (34.4% versus 20.4%). Professional satisfaction was similar between genders, driven primarily by patient care and intellectual stimulation. More women (40.7%) considered parenthood to have a strong negative impact on their career, compared with men (9.0%). Main perceived barriers to gender equality included a lack of work–life balance (72.6% women, 44.4% men), bias of peers and superiors (50.0% women, 18.9% men), and different career goals (41.2% women, 24.4% men). Preferred solutions included educational programs and scholarships (52.9%), communication and leadership training (35.8%), childcare at conferences (33.2%), and postmaternity return-to-work incentives (32.0%).

Conclusion

There is a clear paucity of equal opportunities for female oncologists in Spain. This can be addressed by encouraging professional development and merit recognition particularly for younger female oncologists, and empowering women to be involved in management and leadership of institutions and professional societies.

•

Under-representation of women in leadership roles in oncology is a widely acknowledged issue receiving global attention.

•

This study is a national description of leadership and educational opportunities in terms of gender and family circumstances.

•

Perceptions of gender bias in the workplace gender inequality or family conciliation issues and are described.

•

Initiatives for equal opportunities in oncology are needed supporting female academic career development and recognition.

Situation, challenges, and SEOM recommendations for the future of undergraduate education in Oncology in Spain

PURPOSE

The Spanish Society of Medical Oncology (SEOM, for its Spanish acronym) would like to attest to the relevance of training in Oncology as part of the undergraduate education in Medicine program and issue recommendations to improve said training, with the aim of responding better to the challenges that cancer poses to our society.

MATERIALS AND METHODS

The curricula of 42 schools of medicine were reviewed with interviews with at least one teaching medical oncologist from each faculty. The qualitative and opinion analysis was completed by means of an online questionnaire targeting lecturers, resident tutors, and residents in Medical Oncology (MO), enabling the detection of needs and areas for improvement at an organizational level and in terms of skill acquisition.

RESULTS

While the number of medical schools with a specific, mandatory program in MO has grown by up to 90%, it has not been accompanied by an increase in independent programs. Instead, they largely consist of programs shared with other specialties (61% of the medical faculties). In most of the undergraduate education programs, Oncology contents are fragmented and approached from the perspective of each organ system.

CONCLUSIONS

Despite the positive evolution in recent years, the heterogeneity in Oncology contents during undergraduate education training continues to be remarkable. Cross-sectional programs with an integral vision, taught in the final years of undergraduate medical education would be desirable. Among the recommendations for improvement of training in Medical Oncology, the SEOM proposes that updated, theoretical content be incorporated and clinical practice in Medical Oncology departments be promoted.

Contribution of trastuzumab to the prognostic improvement of HER2-positive early breast cancer in Spain: an estimation of life years and disease-free life years gained since its approval

Introduction: Trastuzumab has become the standard treatment for both HER2-positive early and metastatic breast cancer (HER2+ eBC or mBC) since its approval. The objective of the study is to estimate the benefit of adjuvant trastuzumab in the treatment of patients with HER2+ eBC in terms of life years gained (LYG) and disease-free life years gained (DFLYG) since its approval in Spain in 2006.

Results: 35,851 women make up the cohorts from 2006 to 2017. In the T (trastuzumab)+CT (chemotherapy) scenario, the sum of life years was 605,358 (525,964 disease-free) versus 564,137 (489,916 disease-free) in the CT scenario, resulting in 41,221 LYG (36,048 disease-free) due to trastuzumab. The general population for the same age range would have generated 704,331 LY. The estimated incremental cost was 880.43 million€ (€24,558.13 per patient) from 2006 to 2035. The incremental cost-effectiveness ratios obtained were €20,644 and €23,960 per LYG and DFLYG, respectively.

Methods: An epidemiological model was developed with a time horizon until 2035 and a 3% discount rate. The model compared two scenarios, with and without trastuzumab as adjuvant therapy. The effectiveness data to model the survival curves were obtained from BCIRG 006 study and direct costs were included.

Conclusions: Adjuvant trastuzumab has substantially improved the survival of patients with HER2+ eBC, contributing over 41,000 LYG to Spanish society (over 36,000 DFLYG) in a cost-effective manner. However, the sum of LYG with trastuzumab is still far from the LY estimated for the general population, supporting the need of further advances in HER2+ eBC.

Global Survey of Clinical Oncology Workforce

A lack of well-trained clinical oncologists can result in significant cancer health disparities. The magnitude of this problem around the world is poorly described in the literature. A comprehensive global survey of the clinical oncology workforce was conducted. Data on the number of clinical oncologists in 93 countries were obtained from 30 references. The mortality-to-incidence ratio was estimated by using data on incidence and mortality rates from the GLOBOCAN 2012 database; the ratio was > 70% in 26 countries (28%), which included 21 countries in Africa (66%) and five countries in Asia (26%). Eight countries had no clinical oncologist available to provide care for patients with cancer. In 22 countries (24%), a clinical oncologist would provide care for < 150 patients with a new diagnosis of cancer. In 39 countries (42%), a clinical oncologist would provide care for > 500 patients with cancer. In 27 countries (29%), a clinical oncologist would provide care for > 1,000 incident cancers, of which 25 were in Africa, two were in Asia, and none were in Europe or the Americas. The economic and social development status of a country correlates closely with the burden of cancer and the shortage of human resources. Addressing the shortage of clinical oncologists in regions with a critical need will help these countries meet the sustainable development goals for noncommunicable diseases by 2030.