Editorial
On Oct 21–23, 2014, a meeting to discuss how to tackle the growing burden of cancer in the Gulf region was held in Riyadh, Saudi Arabia. Although currently lower than in Europe and the USA, the burden of cancer in the Middle East is increasing, and is predicted to almost double by 2030. This increase is due, in part, to longer lifespans and adoption of western lifestyle habits (eg, greater use of tobacco; consumption of high-fat, low-fibre diets; and greater physical inactivity). The countries that form the Gulf Corporation Council (GCC)— Saudi Arabia, United Arab Emirates, Bahrain, Oman, Qatar, and Kuwait—are expected to be at the higher end of these predictions for the region, while also being faced with a high burden of infectious diseases. The meeting culminated in a declaration to be submitted for endorsement by the Executive Board of the Health Ministers Council for the GCC States, which listed areas in need of attention and called on member states to reduce cancer mortality by 25% between 2015 and 2025. But can this ambitious target be achieved? Although GCC countries cannot be described as being of low-to-middle income—they are perhaps more accurately described as industrialising—they share many of the same barriers to universal health care that face developing countries. At a systems level, inadequate registration of cancer incidence and death prevents an accurate measure of the burden of the disease, thus hindering proper planning of national and regional cancer-control programmes. Efforts to improve disease registration are underway in the region, but there is still some way to go. Region-specific research is clearly needed to better understand the differences in underlying tumour biology that, for instance, result in about half of cancers in the region presenting at an early age, and to investigate why the pattern of malignancies diagnosed in the Gulf differs from that elsewhere (eg, haematological malignancies, particularly non-Hodgkin lymphomas, are very common in the GCC, possibly as a result of the high prevalence of consanguineous marriages in the region). Further, distinct national cancer plans do not exist for all countries in the region. Some countries, such as Qatar, have taken useful steps forward with the launch of a National Cancer Strategy and a National Cancer Research Strategy, but such action is not universal. Additionally, primary care is generally geared towards acute care rather www.thelancet.com/oncology Vol 15 December 2014
than chronic diseases, whereas in terms of secondary care, cancer treatment facilities are limited in number and of variable quality. To address the low number of facilities would need investment and detailed consideration of the geographical and personal financial barriers that exist for large proportions of the population. There is a growing interest in improving health infrastructure in the region—eg, medical centres of excellence such as King Abdulaziz Medical City in Saudi Arabia are being developed. However, where funding exists, it must be used wisely—eg, is there really a need to build four proton therapy facilities in Saudi Arabia when the country has only half the required number of linear accelerators for its population? At the population and patient level, cultural barriers and educational issues, which together contribute to poor awareness of the disease and of health care in general, must be addressed. Primary prevention measures to successfully reduce exposure to risk factors (eg, tobacco use, poor diet, and little physical activity) are needed. Breaking down social taboos about cancer is also a priority for both primary and secondary prevention— region-specific research into methods to overcome these barriers is vital. Access to essential palliative drugs is restricted in the region, a situation that is unjustifiable, particularly given that most cancers present late and in non-curable stages. Lastly, the provision of universal health care in all Gulf countries should be mandatory: health is a human right, and the rights of all patients to both treatment and psychosocial support are paramount. The disproportionate distribution of wealth in the region is a substantial hurdle to accessing care for a large part of the population, which hinders efforts towards universal care. It is heartening that the Riyadh meeting discussed many of these issues in depth. Once the meeting’s declaration is endorsed by the GCC health ministers, it is of the utmost importance that a detailed implementation plan is devised with specific means, quantifiable milestones, and specific timelines set out to meet the pledge to reduce cancer mortality in line with WHO directives. Hopefully, this unique opportunity to transform words into firm action in the Gulf states will not be missed and the region will be able to work together strategically to deliver good quality cancer care for all. ■ The Lancet Oncology
Gavin Hellier/Robert Harding World Imagery/Corbis
Addressing the burden of cancer in the Gulf
For The Lancet’s Health in the Arab World Series see http:// www.thelancet.com/series/ health-in-the-arab-world For more on Qatar’s cancer plans see Health-care Development Lancet Oncol 2012; 13: e501–08
1407
On Oct 21–23, 2014, a meeting to discuss how to tackle the growing burden of cancer in the Gulf region was held in Riyadh, Saudi Arabia. Although currently lower than in Europe and the USA, the burden of cancer in the Middle East is increasing, and is predicted to almost double by 2030. This increase is due, in part, to longer lifespans and adoption of western lifestyle habits (eg, greater use of tobacco; consumption of high-fat, low-fibre diets; and greater physical inactivity). The countries that form the Gulf Corporation Council (GCC)— Saudi Arabia, United Arab Emirates, Bahrain, Oman, Qatar, and Kuwait—are expected to be at the higher end of these predictions for the region, while also being faced with a high burden of infectious diseases. The meeting culminated in a declaration to be submitted for endorsement by the Executive Board of the Health Ministers Council for the GCC States, which listed areas in need of attention and called on member states to reduce cancer mortality by 25% between 2015 and 2025. But can this ambitious target be achieved? Although GCC countries cannot be described as being of low-to-middle income—they are perhaps more accurately described as industrialising—they share many of the same barriers to universal health care that face developing countries. At a systems level, inadequate registration of cancer incidence and death prevents an accurate measure of the burden of the disease, thus hindering proper planning of national and regional cancer-control programmes. Efforts to improve disease registration are underway in the region, but there is still some way to go. Region-specific research is clearly needed to better understand the differences in underlying tumour biology that, for instance, result in about half of cancers in the region presenting at an early age, and to investigate why the pattern of malignancies diagnosed in the Gulf differs from that elsewhere (eg, haematological malignancies, particularly non-Hodgkin lymphomas, are very common in the GCC, possibly as a result of the high prevalence of consanguineous marriages in the region). Further, distinct national cancer plans do not exist for all countries in the region. Some countries, such as Qatar, have taken useful steps forward with the launch of a National Cancer Strategy and a National Cancer Research Strategy, but such action is not universal. Additionally, primary care is generally geared towards acute care rather www.thelancet.com/oncology Vol 15 December 2014
than chronic diseases, whereas in terms of secondary care, cancer treatment facilities are limited in number and of variable quality. To address the low number of facilities would need investment and detailed consideration of the geographical and personal financial barriers that exist for large proportions of the population. There is a growing interest in improving health infrastructure in the region—eg, medical centres of excellence such as King Abdulaziz Medical City in Saudi Arabia are being developed. However, where funding exists, it must be used wisely—eg, is there really a need to build four proton therapy facilities in Saudi Arabia when the country has only half the required number of linear accelerators for its population? At the population and patient level, cultural barriers and educational issues, which together contribute to poor awareness of the disease and of health care in general, must be addressed. Primary prevention measures to successfully reduce exposure to risk factors (eg, tobacco use, poor diet, and little physical activity) are needed. Breaking down social taboos about cancer is also a priority for both primary and secondary prevention— region-specific research into methods to overcome these barriers is vital. Access to essential palliative drugs is restricted in the region, a situation that is unjustifiable, particularly given that most cancers present late and in non-curable stages. Lastly, the provision of universal health care in all Gulf countries should be mandatory: health is a human right, and the rights of all patients to both treatment and psychosocial support are paramount. The disproportionate distribution of wealth in the region is a substantial hurdle to accessing care for a large part of the population, which hinders efforts towards universal care. It is heartening that the Riyadh meeting discussed many of these issues in depth. Once the meeting’s declaration is endorsed by the GCC health ministers, it is of the utmost importance that a detailed implementation plan is devised with specific means, quantifiable milestones, and specific timelines set out to meet the pledge to reduce cancer mortality in line with WHO directives. Hopefully, this unique opportunity to transform words into firm action in the Gulf states will not be missed and the region will be able to work together strategically to deliver good quality cancer care for all. ■ The Lancet Oncology
Gavin Hellier/Robert Harding World Imagery/Corbis
Addressing the burden of cancer in the Gulf
For The Lancet’s Health in the Arab World Series see http:// www.thelancet.com/series/ health-in-the-arab-world For more on Qatar’s cancer plans see Health-care Development Lancet Oncol 2012; 13: e501–08
1407
