title: Forecasting the impact of stereotactic ablative radiotherapy for early-stage lung cancer on the thoracic surgery workforce.
abstract: OBJECTIVE
  To predict variation in thoracic surgery workforce requirements with the introduction of stereotactic ablative radiotherapy (SABR) for the treatment of early-stage non-small-cell lung cancer (NSCLC).
  
  
  METHODS
  Using Canadian census microdata and the Canadian Community Health Survey, a microsimulation model representing the national population was developed. The demand component simulates the incidence of lung cancer, incorporating the impact of computed tomography (CT) screening for high-risk individuals (>30 pack-year smoking history; age 55-74 years). The supply component simulates the number of thoracic surgeons. SABR was introduced into the model to predict changes in the number of operable NSCLC cases per thoracic surgeon, modelling 30, 60 and 90% compliance with SABR for Stage IA and then for both Stage IA and IB NSCLC.
  
  
  RESULTS
  In the absence of SABR, the volume of operative NSCLC per surgeon increases by a peak of 49.4% (by 2027) and then gradually declines to the present day volume by 2049. More dramatic decreases are seen with increasing compliance with SABR for Stage IA/IB NSCLCs. If the number of new surgeons entering the workforce per year were reduced by 33%, the operative volume per surgeon would increase by a peak of 57.1% (30% Stage IA SABR compliance) and would decrease by up to 49.1% (90% Stage IA SABR compliance).
  
  
  CONCLUSIONS
  With the implementation of SABR for treatment of early NSCLC, there would be a decrease in operative volume. The impact would depend on the stage of NSCLC for which SABR is recommended and on compliance. A national strategy for thoracic surgery workforce planning is necessary, given the complex interaction of CT screening and the treatment of medically operable early NSCLC with SABR.
authors.affiliation: Division of Thoracic Surgery, University of Calgary, Calgary, AB, Canada janetpatriciaedwards@gmail.com.
authors.forename: Janet P
authors.initials: JP
authors.lastname: Edwards
authors.affiliation: Division of General Surgery, University of Calgary, Calgary, AB, Canada.
authors.forename: Indraneel
authors.initials: I
authors.lastname: Datta
authors.affiliation: Department of Civil Engineering, University of Calgary, Calgary, AB, Canada.
authors.forename: John Douglas
authors.initials: JD
authors.lastname: Hunt
authors.affiliation: HBA Specto Incorporated, Calgary, AB, Canada.
authors.forename: Kevin
authors.initials: K
authors.lastname: Stefan
authors.affiliation: Division of General Surgery, University of Calgary, Calgary, AB, Canada.
authors.forename: Chad G
authors.initials: CG
authors.lastname: Ball
authors.affiliation: Division of General Surgery, University of Calgary, Calgary, AB, Canada.
authors.forename: Elijah
authors.initials: E
authors.lastname: Dixon
authors.affiliation: Division of Thoracic Surgery, University of Calgary, Calgary, AB, Canada.
authors.forename: Sean C
authors.initials: SC
authors.lastname: Grondin
mesh_terms: D000368:Aged; D002170:Canada / Q000453:epidemiology; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology / Q000532:radiotherapy*; D008875:Middle Aged; D008962:Models, Theoretical; D009367:Neoplasm Staging; D016634:Radiosurgery / Q000379:methods*; D055502:Secondary Prevention / Q000379:methods; D066231:Surgeons / Q000706:statistics & numerical data; D013903:Thoracic Surgery / Q000639:trends; D014057:Tomography, X-Ray Computed; D000078329:Workforce; D016526:Workload / Q000706:statistics & numerical data
keywords: Non-small-cell lung cancer; Stereotactic ablative radiotherapy; Stereotactic body radiotherapy; Workforce planning