By Vijaya Gottumukkala, MD, FRCA
Cancer is a major global public health concern that affects all citizens and communities around the world. Globally, the incidence of cancer is predicted to increase by 50% by the year 2030; and during the same period, cancer-related mortality is projected to increase by 60% to 13.1 million deaths worldwide. This increasing trend in cancer-related mortality exists despite a slow but steady decline in cancer-related death rates since the early 1990s in the United States and the Western world.
Citizens 65 years of age or older have a cancer incidence rate that is 10 times higher than among younger people, while the mortality rate among older cancer patients is 16 times greater than among younger patients. However, cancer is no longer considered a terminal disease. With the implementation of effective cancer prevention education programs, widely available screening programs leading to early diagnosis, and the advent of effective biologic and immunotherapeutic modalities, the profile of cancer is changing to a chronic medical condition.
There are more than 20 million cancer survivors currently living in the United States alone. Of the nearly 20 million new cancer cases worldwide in 2021, more than 80% of cases will need surgery, some several times as curative resection is essential for global cancer control, particularly for patients with solid tumors. It is estimated that by 2030, over 45 million surgical procedures will be needed globally for cancer control. Furthermore, both patients with cancer and cancer survivors will continue to need the services of our specialty in the perioperative setting well beyond their primary cancer care.
As most of the diagnostic and interventional procedural care for patients with cancer is provided in the community setting around the world, this textbook, “Perioperative Care of the Cancer Patient,” will serve the educational needs of anesthesia providers in all settings globally. Each of the chapters is authored by international experts in the field and discusses the current understanding and practices, current controversies and unanswered questions, and the direction for future studies.
I believe this is an exciting time for anesthesiology and perioperative medicine as we continue to partner with oncology and other specialties to break down silos and work together to improve postoperative outcomes and increase disease-free survival.
Gottumukkala is a professor of anesthesiology and perioperative medicine at The University of Texas MD Anderson Cancer Center, in Houston. He is also the medical director of the Advancement of Perioperative Cancer Care program, and the associate head of the Institute for Cancer Care Innovation.
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Thank you for the link!
Long-term outcomes of anesthesia is a long overdue topic and one of the most important is the effect of anesthesia on cancer recurrence. I'm not an expert but it seems to be well established that cell salvage and retransfusion of the patient's own blood decreases cancer recurrence by about a third and it is almost sure that TIVA decreases the recurrence and improves survival by about 20% or more. One surprising thing is that many studies on TIVA included remifentanil in the treatment group and still have shown the benefit - meaning either avoidance of halogenated agent was more important than using an opioid, or, a weird thought, the presence of glycine is somehow beneficial. Theoretically, combination of propofol and lidocaine should be the best, right?
Anyway, these data accumulate over more than twenty years, we still don't want to recognize it, and for a good reason: does anyone want to be sued for recurrence five years after the surgery - but ultimately, we won't have a choice.