ASSESSING THE INFLUENCE OF MEDICAL EDUCATION REFORMS ON ONCOLOGIST WORKFORCE AND LUNG CANCER MORTALITY IN KAZAKH-STAN: AN INTERRUPTED TIME SERIES ANALYSIS WITH PREDICTIVE MOD-ELING OF NATIONWIDE DATA FROM 1998 TO 2023.

Background: Lung cancer continues to be a significant global health challenge, accounting for the highest cancer-related mortality worldwide. Despite considerable advances in understanding the disease and improving treatment modalities, survival rates remain alarmingly low, largely owing to the high incidence of lung cancer, which is predominantly attributable to smoking. In Kazakhstan, key reforms in oncologist training were introduced in 2008 and 2020 - replacing short-term oncology courses with a standardized multi-year clinical residency program - in an effort to improve the quality and availability of specialized cancer care. This study evaluates the impact of recent reforms in oncologist training in Kazakhstan on the number and distribution of oncologists and examines the correlation between these changes and lung cancer mortality rates from 1998-2023.

Methods: Interrupted time series analysis (ITSA) using best-fit epidemiological model was conducted to examine the impact of medical education reforms on the number and PMP rates of oncologists in Kazakhstan, as well as their impact on the mortality of lung cancer patients.

Results: The lung cancer mortality rates per 100,000 population ranged from 20.24 to 10.12, with a consistent downward trend observed throughout the study period. The total number of oncologists ranged from 499 to 1219, reflecting an increasing trend throughout the study period. Significant disparities were observed between urban and rural areas, with the number of oncologists in urban settings being six times greater than that in rural areas.

Conclusion: This study underscores the urgent need for continued reforms in medical education and training to strengthen the oncology workforce in Kazakhstan. The findings reveal pronounced disparities between urban and rural regions, as well as the adverse effects of abolishing short-term training programs on rural areas. To address these challenges, targeted policies are required to mitigate rural shortages, expand flexible training opportunities, and introduce incentives that support the recruitment and retention of specialists in underserved regions. Such measures are critical to improving equity in access to oncological care and reducing lung cancer mortality.