Arab World Cancer Declaration, 2010. (Initiative To Improve Cancer Care in The Arab World)

Initiative to Improve Cancer Care
in the Arab World

TABLE OF CONTENTS
H.E. Dr. Knawy Message ………………………………………………………………………. 1

Chairperson Introduction ………………………………………………………………………. 2

Meeting Summary Report ………………………………………………………………………. 3

Arab World Cancer Declaration ………………………………………………………………………. 12

12 month projects ………………………………………………………………………. 31

Individual Panels Report ………………………………………………………………………. 33

Establishing Cancer Screening Early Detection
and Prevention Program ………………………………………………………….. 34
Human Resources Development ……………………………………………… 51

Tobacco Control ………………………………………………………………………. 64
Access to Cancer Care Facilities ………………………………………………………….. 78
Diagnosis of Cancer ………………………………………………………………………. 87
Overcoming the Challenges of Pediatric Cancer
Care in the Arab World ………………………………………………………………………. 98
Funding Cancer Care ………………………………………………………………………. 113
Standards of Care and Guidelines in the
Arab Countries with Limited Resources ……………………………………………… 137
Tumor Registry …………………………………………………………………………………… 145
Research Development Priorities
Access to Cancer Care Medication …..…………………………………………. 158
Access to Palliative Care ………………………………………………………………………. 175
National Cancer Policy and Control Program ………………………………………. 199
Research Development Priorities …………………………………………….. 210

Introduction by
H.E. Dr. Bandar Al Knawy
Chief Executive Officer, NGHA

It is with great pleasure I introduce this Inaugural Report of the
Initiative to Improve Cancer Care in the Arab World (ICCAW) which
was held in Riyadh on March 23 – 25, 2010.

The report is the fruit of tireless efforts of many individuals who worked on
preparation and organizing the meeting, and many participants who worked
collaboratively to change this event into a very successful endeavor. The initiative is
remarkable undertake due to high level of expertise, professionalism, dedication,
cooperation and team work.

This Initiative is another testimonial gesture for our Kingdom strive to alleviate the
suffering of people and improve their quality of life which reflects the deep
conviction of our Kingdom in its humanitarian role as “Kingdom of Humanity” under
the leadership of the Custodian of the Two Holy Mosques, King Abdullah bin
Abdulaziz.

Finally, I want to express my sincere appreciation and gratitude to all who put efforts
into this initiative at all levels along with my full support to their cause and best
wishes for their success.

H.E. Dr. Bandar Al Knawy
Chief Executive Office
National Guard Health Affairs

Initiative to Improve Cancer Care in the Arab World 1

Chairperson Introduction

After many months of hard work and collaborative efforts from different individuals
across the Arab World, the Initiative to Improve Cancer Care in the Arab World was
held in Riyadh, KSA, on March 23 – 25, 2010.

Various panels were formed of facilitators, members, international and regional
experts. These panels conducted analysis of the cancer care in the region and put
forth recommendations to improve the care in their respective area of work.

The panels reports are compiled in this document which consists of review of the
current situation and specific recommendation for improvement. The summary
recommendations were compiled into the Arab World Cancer Declaration.

Short term “12 months” projects were selected to keep the panel engaged and move
the process a step forward toward the strategic goals.

We are thankful to all participants, guests, supporting organizations and sponsors.

We hope that this initiative will ignite the change process in improving the cancer
care across our beloved nation.

Abdul Rahman Jazieh, MD, MPH
Chairman, Scientific Committee
Initiative to Improve Cancer Care in the Arab World
Chairman, Department of Oncology

Dr. Sami Al Khatib
Secretary General
Arab Medical Association Against Cancer

Dr. Omalkhair Abulkhair
Section Head, Division of Adult Medical Oncology
Department of Oncology, KAMC – NGHA, Riyadh

Meeting Summary Report

Initiative to Improve Cancer
Care in the Arab World



Dr. Sami Al Khatib
Secretary General


Scientific Committee

Chairpersons:

Abdulrahman Jazieh, MD, MPH
KAMC – NGHA, Riyadh

Dr. Sami Al Khatib
Secretary General


Committee Members:

Dr. Reem Al Sudairy
Deputy Chairman and Section Head, Division of Pediatric Hematology/Oncology,

Dr. Faisal Al Safi
Section Head, Division of Gynecology Oncology, Department of Oncology

Dr. Mohammad Jarrar
Consultant, Division of Pediatric Hematology/Oncology, Department of Oncology

Dr. Omar Shamieh
Consultant, Division of Palliative Care, Department of Oncology, KAMC – NGHA,
Riyadh

Ms. Susan Volker
Operations Administrator, Department of Oncology, KAMC – NGHA, Riyadh

Ms. Susan Young
Data Manager, Department of Oncology

Dr. Alamin Berhanu
Course Coordinator
Postgraduate Training Center KAMC – NGHA, Riyadh

Organizing Committee

Dr. Abdullah A. Al Shimemeri
Dean
Postgraduate Education & Academic Affairs
King Saud bin Abdulaziz University for Health Sciences
KAMC, NGHA
Riyadh, Kingdom of Saudi Arabia

Dr. Abdulrhman Al Fayez
Associate Dean
KAMC, NGHA

Abdulrahman Jazieh, MD, MPH
Chairman
Department of Oncology
KAMC, NGHA

Ms. Manal Al Nasser
Director
Postgraduate Training Center
KAMC, NGHA

Dr. Mohammad Khairy Fairaq
Finance Manager
KAMC, NGHA

Dr. Alamin Nasser Berhanu
Course Coordinator

Ms. Marie Gretchen Datario
Administrative Assistant
KAMC, NGHA

Mr. Arvin Santos
Graphic Artist
KAMC, NGHA

Mr. Marzen Buenaventura
Administrative Assistant (www.iccaw.com web designer)
KAMC, NGHA

Participating Organizations:

a. World Health Organization (WHO)
b. International Union Against Cancer (UICC)
c. Saudi Cancer Society
d. Saudi Ministry of Health
e. Arab‐European School of Oncology
f. European Society of Medical Oncology
g. Sanad
h. Zahra
i. Saudi Cancer Foundation
j. Gulf CC Health Council
k. Bahrain Cancer Society
l. Asian Pacific Organization for Cancer Prevention and Control/UICC
Asian Regional Office for Cancer Control (APOCP/UICC‐ARO)

Introduction:
The Inaugural Conference to launch the Initiative to Improve Cancer Care in the Arab
World was held on March 23 – 25, 2010, Riyadh, KSA.

The idea was generated by the NGHA Oncology Department and organized with Arab
Medical Association Against Cancer with the participation of prestigious
international and national organizations such as World Health Organization (WHO),
International Union for Cancer Control (UICC), Saudi Ministry of Health, Saudi Cancer
Society and others.

Initiative Objectives:

1. To develop strategic recommendations to improve cancer care in the Arab
countries.
2. To facilitate networking, experiences sharing, cooperation and collaborative

projects across the Arab world.
3. To recommend specific action steps pertinent to our countries in order to
improve cancer care in the region.
Pre‐Conference Arrangement:
The important topics related to cancer care were identified in coordination with
WHO and the following panels/working group were formed as shown in the table:
Panel Name Objectives
1A. National Strategies and Cancer • Discuss WHO/IARC plans to improve cancer care.
Control Programs • Present ongoing initiatives in the Arab countries.
• Present recommendations on establishing National
Cancer Control Programs.
1B. Funding Cancer Care • Discuss role of government and non‐government
agencies (NGOs).
• Discuss the role of pharmaceutical companies.
• Present recommendations on fund raising for cancer
care.
1C. Cancer Early Detection and • Describe the current screening and prevention
Screening programs in the region
• Discuss the challenges of the establishing screening
and prevention programs
• Present recommendations and future steps to
develop cancer screening programs in the Arab
region
1D. Tumor Registries • Discuss the importance of tumor registries and their
functions.
• Present current registries experience in the Arab
countries
• Present recommendation of how to improve
registries functions and collaborations.

2A. Human Resources Development • Overview the global shortage of well trained
health care personnel.
• Present regional initiatives to develop human
resources.
• Present recommendations on how to address
this issue.
2B. Tobacco Control • Describe the epidemic of tobacco use in the Arab
countries in context of the global picture.
• Present the challenges and the barriers to
tobacco control
• Present the ongoing initiatives to for tobacco
control in the region
• Present recommendations and future steps to
contain the danger of tobacco use
2C. Access to Cancer Care Facilities • Describe the current status of cancer centers.
• Present the need assessment for cancer center.
• Present recommendation on establishing Cancer
Care facilities that addresses the spectrum of cancer
care (diagnosis – treatment)
3 A. Standard of Care and Guidelines • Discuss briefly the impact of limited resources on
for the Arab Countries standard of care.
• Present regional experience in setting guidelines (e.g.
MENA NCCN)
• Present recommendations on addressing standard of
care issues in the Arab Countries.
3 B. Access to Cancer Medications • Describe the challenges of access to cancer
medications.
• Review the status of pharmaceutical industry in
the Arab World.
• Discuss options on how to obtain these
mediations.
3C. Research Development Priorities in • Overview of Research challenges in the Arab
the Arab Countries countries.
• Overview of research activities in Arab countries.
• Present recommendations on building research
structure and culture.
• Present recommendation on setting priorities for
research.

4A. Diagnosis of Cancer • Present challenges to laboratory and imaging
diagnosis in the Arab World.
• Present recommendation to improve cancer care
diagnosis capabilities in the Arab world.
4B. Access to Palliative Care • Assess the current situation of Palliative Care in the
Arab World.
• Discuss challenges and needs for Palliative Care in
the region
• Present recommendation and strategic steps to
improve the Palliative Care
4C. Overcoming the Challenges of • Present challenges to laboratory and imaging
Pediatric Cancer Care in the Arab diagnosis in the Arab World.
World • Present recommendation to improve cancer care
diagnosis capabilities in the Arab world.

13 Panels included the following individuals: 1 to 3 facilitators, up to 20 panel
members, international advisors, experts and administrative assistants.

A Pre‐Conference Initial Assessment and Recommendation Tool was utilized to
obtain input from participants. (Appendix I)

The feedbacks were compiled into one document which was distributed to all
members for discussion at the meeting

Activities during the Conference:

The Conference has the following types of activities (Appendix II).
1. Plenary sessions 1‐3: Include presentations by world experts in cancer
related topics. They addressed the topics in global fashion and reflected on
its relevance to our region.
2. Breakout sessions: Include the panel members with the help of the
international experts in the particular topics. It offered a chance for personal
interaction among the facilitators, experts and panel members. The breakout
session activities include:
a. Agreement on the consensus recommendations including at least one
long term strategic objective with action steps.
b. Planning the short term project to be achieved in the next 12 month.
A document will be generated from the meeting in uniformed publishable
format.
3. Plenary Session 4 ‐ 5: The panels presented their recommendations and
action steps to all attendees.
4. Satellite Symposia (4): Address specific clinical topics of interest to the
practicing physicians in order to have valuable attractive educational events
for attendees and will be organized by sponsors.
Conference Statistics:
a. 13 Panels/Working Groups
b. 26 Lectures/Presentation
c. 4 Satellite Symposia
d. 17 International Speakers, Experts and Advisor
e. 10 Participating Organizations
f. 206 Guests
g. 116 Panel Members
h. 16 Countries

The Meeting Outcomes:

The following are some of the Conference outcomes:

1. The Inaugural Report (under preparation): All panels were requested to
generate a specific report including background, strategic recommendation
with action steps, 12 month panel specific project and list of all available
resources relevant to the panel area. The report will be completed by the end
of April.
2. Arab World Cancer Declaration: (Appendix III)
Each panel submitted one strategic objective to be achieved by 2020 with
limited number of milestones action steps. These 2020 objectives were
compiled to form the Arab World Cancer Declaration.
3. Individual Panel 12 Month Project: (Appendix IV)
Each panel submitted at least one 12 months project and one alternative
project. These project contain action steps and required resources to assure
that they are achievable within the set period.
4. Educational/Learning Value:
The components of the program included many unique features and
opportunities for learning and skill development:
a. Standard classic plenary didactic lectures with top‐notch speakers.
b. The breakout session of the panels were unique experience due to the
following reasons:
• Different type of thinking process and actions:
o Educational Activity
o Brain Storming / Reflective Thinking
o Forward Thinking
o Strategic Vision
o Practical Approach
o Collaborative Effort
o Proactive Involvement
o Disciplined Process
o Documented Work
• Team work skills and spirit
• Leadership skills for the facilitators to be able to moderate the
group and build consensus about the recommendation.
• Mentoring opportunities for the group from the session members
and the international expert and advisors.

5. Emergence of Potential Common Areas of Interest such as:
a. Regional Research Network
b. Pediatric Oncology Network
c. Pan Arab Automated Tumor Registry.
d. Developing Oncology Advisory Group for Arab Board for Medical
Specialties.

Finally, the Inaugural Conference created a spirit of collaboration, optimism and
hope to do the best for our cancer patients.

We should strive to build on this momentum to generate the best outcome.

Arab World Cancer Declaration
March 25, 2010
(9, Rabi II, 1431)

A CALL FOR A STRATEGIC APPROACH TO
OPTIMIZE CANCER CARE IN THE ARAB WORLD

On March 25th, 2010 (9, Rabi II 1431), the Inaugural Conference of the “Initiative to
Improve Cancer Care in the Arab World (ICCAW)” identified the need for a strategic
approach to be taken by all relevant entities, including governmental and non‐
governmental agencies, health care providers, policy makers and communities at large, to
optimize cancer care across the Arab world.

This Declaration evolved based upon direct inputs from experts and leaders in the field
from across the Arab World participating in thirteen interactive panels during the ICCAW
Inaugural Conference. The panels each were tasked with prioritizing objectives for
achievement by 2020. In addition, each panel recommended key action steps to be
accomplished in the near term to advance towards achievement of these objectives. The
combined themes of these panels result in a taxonomy for comprehensive cancer care and
control. (Fig. 1)

As a result of this systematic and practical approach, panel leaders and experts were able
to reach a consensus to adopt the following “Arab World Cancer Declaration” in order to
achieve specific core objectives by the year 2020.

The panel experts wish to recognize the World Cancer Declaration (UICC, 2006)1 and A
Strategy for Cancer Control in the Eastern Mediterranean Region 2009‐2013 (WHO 2008)2,
as invaluable resources aiding the development of this Initiative.

Figure 1. Taxonomy for Comprehensive Cancer Care and Control in the Arab World

Tobacco
Diagnosis
Control
Early
Access Detection &
to Prevention Pediatric
Facilities Cancer
Funding Policy Human

Resources
Access Palliative
To Registries & Care
Medications Data
Research Guidelines

PRIORITY OBJECTIVES FOR 2020 AND KEY ACTION STEPS

OBJECTIVE 1 (POLICY): Implement a National Cancer Control Plan in each country.

Action Steps:
i. Establish a Pan‐Arab Cancer Control Advisory Committee.
ii. Establish a National Cancer Control Committee in each country.
iii. Adapt the WHO Cancer Control Strategy.
iv. Develop/review National Cancer Control plan in line with the WHO
Regional Cancer Control Strategy.
v. Establish a cancer control database (stakeholder organizations) in
each country.

OBJECTIVE 2 (FUNDING): Establish reliable and sustainable fund‐raising strategies for
each country, utilizing existing effective fund‐raising models and tailored to
meet the needs and capacity of that country.

Action Steps:
i. Collaborate with non‐governmental organizations (NGOs).
ii. Provide training/teaching for fundraising management.
iii. Utilize available regional and international fundraising models.

OBJECTIVE 3 (EARLY DETECTION & PREVENTION): Establish accessible and effective
national screening and early detection programs in each country.

Action Steps:
i. Establish a Central Steering Committee, with representatives from
each participating country.
ii. Develop training programs for primary health care physicians and
other health care professionals.
iii. Develop standard plans for cancer center early diagnosis and
screening.
iv. Identify and review existing screening and detection services and
create a reliable screening infrastructure for specific cancers.
v. Follow unified cancer screening selection criteria.
vi. Increase efforts to reduce obesity and improve nutrition and life style
(physical activity)

OBJECTIVE 4 (TOBACCO CONTROL): Decrease all forms of tobacco consumption in all
Arab countries (as an additional key component of Prevention).

Action Steps:
i. Intensify public awareness campaigns, through the use of public
media and community education programs.
ii. Support enforcement of anti‐tobacco legislation, such as banning

tobacco smoking in public and establishing a minimal legal age for
smoking.
iii. Advocate for legislation to increases tobacco taxation and for revenue
from tobacco taxes to be allocated to cancer research.

OBJECTIVE 5 (HUMAN RESOURCES): Substantially improve human resource capacities
in all professions aligned to supporting goals for comprehensive cancer care

Action Steps:
i. Increase the number of academic programs for various disciplines
related to cancer care.
ii. Establish continuing education, training and development programs
for practicing professionals.
iii. Improve practice standards to enhance professional satisfaction, staff
recruitment and retention, and ultimately improved cancer patient
outcomes.
iv. Improve professional, academic and community awareness of the
need for qualified experienced cancer care professionals and the
added value they give to the quality of cancer care.

OBJECTIVE 6 (REGISTRIES AND DATA): Establish a Pan‐Arab automated cancer registry
network that meets current international standards and develop at least
minimum epidemiology and related data across the Arab world.

Action Steps:
i. Establish a Regional Steering Committee.
ii. Develop regional cancer data standards.
iii. Define minimum data required to be shared.
iv. Establish mechanisms of data networking and transfer.
v. Establish standards for data reporting and utilization.
vi. Establish mechanisms for incidence and prevalence reporting, and for
patient surveillance and follow up.

OBJECTIVE 7 (RESEARCH): Initiate and conduct rigorous, collaborative cancer research
activities, in all Arab countries, according to resource availability.

Action Steps:
i. Establish a Pan Arab Cancer Research Steering Committee.
ii. Promote active participation of oncology clinicians in clinical trials and
other relevant research.
iii. Establish research training programs, open to researchers throughout
the region.
iv. Establish a Pan Arab Cancer Research Collaborative Network.
v. Promote translation of findings into clinical practice, as appropriate

for each country.
vi. Establish cancer care “Outcomes and Effectiveness Research” centers
and programs in the region.

OBJECTIVE 8 (GUIDELINES): Ensure that the standards of care and management of the
majority of cancer patients in Arab countries are based on evidence‐derived
guidelines.

Action Steps:
i. Establish a multidisciplinary regional Guidelines Steering Committee.
ii. Adapt currently accepted guidelines to meet cultural expectations and
resource availabilities.
iii. Modify guidelines based on emerging evidence from the region.
iv. Establish effective and sustainable outcomes monitoring and
evaluation systems.

OBJECTIVE 9 (DIAGNOSIS): Ensure all cancer diagnostic testing in the Arab World is
conducted following the highest international standards and quality control
regulations.

Action Steps:
i. Establish a Regional Steering Committee to oversee the regulation,
development and implementation of diagnostic standards.
ii. Establish practice guidelines for referring physicians and radiologists.
iii. Develop virtual national reference centers for cancer diagnostics.
iv. Establish procedures in cancer centers that complex cases (such as
unusual case presentation or failure to respond to treatment) are
reviewed and discussed by a multidisciplinary team and resulting in a
written plan of care.

OBJECTIVE 10 (ACCESS TO FACILITIES): Identify inequities in cancer care facilities to
service cancer detection and management needs and resource allocation in all Arab
countries

Action Steps:
i. Establish a panel of experts in the field tasked to make
recommendations for priority setting and facility resource allocation
in each country.
ii. Conduct mapping of cancer care facilities in each country
iii. Establish standards to establish access to cancer facilities for
screening and care in primary, secondary and tertiary settings in each
country, based on population need and geographic burden of disease.
iv. Determine appropriate allocation processes to improve access to
cancer facilities in each country based upon these standards

OBJECTIVE 11 (ACCESS TO MEDICATIONS): Ensure that adequate access to cancer
medications for cancer patients is thoroughly studied, lobbied and applied
based upon scientific evidence.

Action steps:
i. Complete a baseline situational analysis on access to cancer
medications.
ii. Secure sufficient funding for cancer drug therapies.
iii. Ensure availability of health policies that address access to cancer
medications.
iv. Establish and execute regional and international ‘exchange of expertise’
programs.

OBJECTIVE 12 (PALLIATIVE CARE): Promote the integration of comprehensive
palliative care for all cancer patients throughout the Arab World.

Action Steps:
i. Increase palliative care awareness through advocacy and networking.
ii. Identify gaps, needs and available resources for palliative care
throughout the Arab World.
iii. Promote the development of country‐specific palliative care strategic
plan.
iv. Promote the adaptation and integration of palliative care curricula in
the existing curricula for all health care providers, at all levels.
v. Establish palliative care training programs from basic to specialty
levels.
vi. Promote the availability of and access to essential opioids and other
palliative medications for all cancer patients.
vii. Promote the development of palliative care services at all levels of
care, including community services, for all age groups.
viii. Establish, implement and evaluate palliative care standards across
advocacy, service provision, education, training, monitoring and
research.

OBJECTIVE 13 (PEDIATRIC CANCER): Reduce morbidity and mortality of pediatric
cancer
patients in the Arab World.

Action Steps:
i. Form a regional network that will facilitate the development of
pediatric cancer care programs in all Arab countries.
ii. Develop a proposal for pediatric hematology/oncology physician
fellowships and submit to the Arab Board/Local Boards for
accreditation.
iii. Establish Regional Training Programs for pediatric
hematology/oncology nurses, including advanced nurse practitioners,
and for other pediatric oncology specialist supportive care providers
such as dietitians, patient educators, and clinical pharmacists, social
workers and psychologist.
iv. Establish a pediatric palliative care program in each Arab country.
v. Create national and regional databases for pediatric cancer.

These objectives can be achieved through collaborative associations with regional
governmental and non‐governmental organizations, academic institutions and
concerned individuals and also by forming partnerships with international
organizations, institutions, industry, and experts.

A quarterly update of committee activities will be provided to ICCAW leadership and
an annual status report will be generated for submission to the appropriate
participating country authorities.

Signed on behalf of the participating individuals and organizations:
On the 24th of April 2010.

_________________________________
Initiative to Improve Cancer Care in the
Arab World

_________________________________
Co‐Chairperson, Scientific Committee
Initiative to Improve Cancer Care in the
Arab World

_________________________________
Dr. Sami Khatib
Secretary General, Arab Medical Association Against Cancer

_________________________________
H.E. Dr. Bandar Al Knawy, MD FRCPC
Chief Executive Officer, National Guard Health Affairs &
President, King Saud bin Abdulaziz University for Health Sciences
Riyadh, KSA
PANEL FACILITATORS:

National Strategies and Cancer Control Plan
Dr. Abdullah Al Amro, Saudi Cancer Society, King Fahad Medical City, Saudi Arabia

Funding Cancer Care
Dr. Sherif Abouelnaga, Childrens Cancer Hospital Egypt 57357, Egypt
Dr. Falah Al Khatib, Gulf International Cancer Center, UAE

Early Detection and Prevention
Dr. Omalkhair Abulkhair, National Guard Health Affairs, Saudi Arabia
Dr. Faisal Al Safi, National Guard Health Affairs, Saudi Arabia
Dr. Dorria Salem, Cairo University, Egypt

Tobacco Control
Dr. Nagi El Saghir, American University of Beirut, Lebanon
Dr. Elsayed Salim, Rustaq Faculty of Applied Sciences, Oman

Human Resources Development
Dr. Adbulrahman Jazieh, National Guard Health Affairs, Saudi Arabia

Registries & Data
Dr. Ali Al Zahrani, Gulf Center for Cancer Registration, Saudi Arabia
Dr. Shouki Bazarbashi, King Faisal Specialist Hospital and Research Center, Saudi
Arabia

Diagnosis of Cancer
Prof. Asma Al Adabbagh, King Abdulaziz University Hospital (Jeddah), Saudi Arabia
Dr. Abdulmohsen Al Kushi, National Guard Health Affairs, Saudi Arabia

Standards of Care and Guidelines for the Arab Countries
Dr. Nagi Saghir, American University of Beirut, Lebanon
Dr. Hamdy Abdul Azim, Cairo University, Egypt

Research Development Priorities in the Arab Countries
Dr. Ali Shanqeeti, King Abdulaziz City of Science and Technology, Saudi Arabia
Dr. Sana Al Sukhun, University of Jordan, Jordan

Access to Cancer Care Facilities
Dr. Fady Geara, American University of Beirut, Lebanon
Ms. Rabab Diab, King Hussein Institute for Biotechnology and Cancer, Jordan

Access to Cancer Care Medications
Dr. Ahmed Saadeddin, Riyadh Military Hospital, Saudi Arabia
Dr. Nour Obeidat, King Hussein Institute for Biotechnology and Cancer, Jordan

Access to Palliative Care
Dr. Omar Shamieh, National Guard Health Affairs, Saudi Arabia
Dr. Rafa Al Shehri, National Guard Health Affairs, Saudi Arabia
Dr. Mohammed El Foudeh, King Faisal Specialist Hospital and Research Center, Saudi
Arabia

Overcoming the Challenges of Pediatric Cancer Care in the Arab World
Dr. Reem Al Sudairy, National Guard Health Affairs, Saudi Arabia
Dr. Mohammad Jarrar, National Guard Health Affairs, Saudi Arabia

INTERNATIONAL ADVISORS AND EXPERTS

Dr. Tony Miller,
Dalla Lana School of Public Health
Canada

Dr. Cecilia Sepulveda
World Health Organization
Switzerland

Dr. Franco Cavalli,
Oncology Institute of Southern Switzerland
Switzerland

Dr. Ibtihal Fadhil
Egypt

Prof. Jean‐Jacques Zambrowski
Bichat University Hospital
France

Dr. Ben Andersonr
UWMC‐Roosevelt Facility
USA

Dr. Alex Adjei
Roswell Park Cancer Insititute
USA

Dr. Fadwa Attiga
Basic Scientist
Jordan

Dr. Raul Ribeiro
St. Jude Children's Research Hospital
USA

Dr. David Kerr
Sidra Medical and Research Center
Qatar
Dr. Mhoira Leng
Cairdeas International Palliative Care Trust
Kampala
Dr. Ghassan Abou Alfa
Memorial Sloan Kettering Cancer Center
USA

Dr. Barri Blauvelt
Institute for Global Health, University of Massachusetts
USA

Dr. Leslie Lehmann
Boston Children’s Hospital
Harvard Medical School
USA

Ms. Kathleen Houlahan
Boston Children’s Hospital
Harvard Medical School
USA

ORGANIZING AGENCIES:
National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences

Arab Medical Association Against Cancer (AMAAC)

PARTICIPATING ORGANIZATIONS:
International Union Against Cancer (UICC)
Saudi Ministry of Health
Saudi Cancer Society

Arab‐European School of Oncology
European Society for Medical Oncology
European School of Oncology
Sanad Children’s Cancer Support Society
Zahra Breast Cancer Assocation
Saudi Cancer Society
Gulf Cancer Center Health Council
Bahrain Cancer Society

TAXONOMY:
Positioning of the themes in Figure 1: Taxonomy for Comprehensive Cancer Care and
Control in the Arab World is intended to help the reader visualize the
interrelationship of the themes addressed in this Declaration and is not intended to
imply degree of importance of one theme over another.

REFERENCES
1. International Union Against Cancer (2006). The World Cancer Declaration.
Retrieved March 25, 2010, from http://www.uicc.org.

2. World Health Organization (2008). A Strategy for Cancer Control in the
Eastern Mediterranean Region 2009‐2013, Draft Final. World Health
Organization Regional Office for the Eastern Mediteranean.WHO‐
EM/NCD/060/E. Retrieved 20 March, 2010 from
http://www.emro.who.int/publications/Book_Details.asp?ID=1002.

‫‪Arab World Cancer Declaration ‬‬
‫‪ ‬‬
‫‪ ‬ﺑﻴﺎن اﻟﻌﺎﻟﻢ اﻟﻌﺮﺑﻲ ﻟﻤﺮض اﻟﺴﺮﻃﺎن‬

‫‪ 25‬ﻣﺎرس ‪2010‬‬
‫‪ 9‬رﺑﻴﻊ اﻟﺜﺎﻧﻲ ‪1431‬‬
‫‪ ‬اﻟﺮﻳﺎض – اﻟﻤﻤﻠﻜﺔ اﻟﻌﺮﺑﻴﺔ اﻟﺴﻌﻮدﻳﺔ‬
‫‪ ‬‬
‫‪ ‬‬
‫‪ ‬‬
‫دﻋﻮى ﻻﺗﺨﺎذ ﻧﻬﺞ اﺳﺘﺮاﺗﻴﺠﻲ ﻟﺘﺤﺴﻴﻦ اﻟﻌﻨﺎﻳﺔ ﺑﻤﺮﺿﻰ اﻟﺴﺮﻃﺎن ﺑﺎﻟﻌﺎﻟﻢ اﻟﻌﺮﺑﻲ ‪ ‬‬
‫ﺣﺪد اﻟﻤﺆﺗﻤﺮ اﻻﻓﺘﺘﺎﺣﻲ " ﻟﻤﺒﺎدرة ﺗﺤﺴﻴﻦ اﻟﻌﻨﺎﻳﺔ ﺑﻤﺮﺿﻰ اﻟﺴﺮﻃﺎن ﺑﺎﻟﻌﺎﻟﻢ اﻟﻌﺮﺑﻲ " ﻓﻲ ‪ 25‬ﻣﺎرس ﻋﺎم ‪ 9 ) 2010‬رﺑﻴﻊ اﻟﺜﺎﻧﻲ‬
‫‪ (1431‬ﺿﺮورة إﺗﺨﺎذ ﻧﻬﺞ اﺳﺘﺮاﺗﻴﺠﻰ ﻣﻦ ﻗﺒﻞ ﻣﺨﺘﻠﻒ اﻟﻤﻜﻮﻧﺎت اﻟﻤﻬﺘﻤﺔ ﺑﺎﻟﻤﻮﺿﻮع ﻣﺘﻀﻤﻨﺎ اﻟﻬﻴﺌﺎت اﻟﺤﻜﻮﻣﻴﺔ وﻏﻴﺮ اﻟﺤﻜﻮﻣﻴﺔ‬
‫وﻣﻘﺪﻣﻲ اﻟﺮﻋﺎﻳﺔ اﻟﺼﺤﻴﺔ وﺻﻨﺎع اﻟﻘﺮار واﻟﻤﺠﺘﻤﻌﺎت ﻋﺎﻣﺔ وذﻟﻚ ﻟﺘﺤﺴﻴﻦ اﻟﻌﻨﺎﻳﺔ ﺑﻤﺮﺿﻰ اﻟﺴﺮﻃﺎن ﻓﻲ اﻟﻌﺎﻟﻢ اﻟﻌﺮﺑﻲ ‪ .‬‬
‫وﻗﺪ ﺻﻴﻎ هﺬا اﻟﺒﻴﺎن ﻣﻦ ﻣﺴﺎهﻤﺎت ﺧﺒﺮاء ﻓﻲ هﺬا اﻟﻤﺠﺎل ﻣﻦ اﻟﻌﺎﻟﻢ اﻟﻌﺮﺑﻲ وﺗﻮﺻﻴﺎت ﺛﻼﺛﺔ ﻋﺸﺮ ﻣﺠﻤﻮﻋﺔ ﻋﻤﻞ ﻣﺸﺎرآﺔ ﻓﻲ اﻟﻤﺆﺗﻤﺮ‬
‫اﻻﻓﺘﺘﺎﺣﻲ " ﻣﺒﺎدرة ﻟﺘﺤﺴﻴﻦ رﻋﺎﻳﺔ ﻣﺮﺿﻰ اﻟﺴﺮﻃﺎن ﺑﺎﻟﻌﺎﻟﻢ اﻟﻌﺮﺑﻲ"‪ ، ‬وﻗﺪ آﻠﻔﺖ آﻞ ﻣﺠﻤﻮﻋﺔ ﻋﻤﻞ ﺑﺘﺤﺪﻳﺪ اﻷهﺪاف اﻷﺳﺎﺳﻴﺔ اﻟﻮاﺟﺐ‬
‫ﺗﺤﻘﻴﻘﻬﺎ ﺑﺤﻠﻮل ﻋﺎم ‪ ، 2020‬وأﻳﻀﺎ أوﺻﺖ آﻞ ﻣﺠﻤﻮﻋﺔ ﻋﻤﻞ ﺑﺨﻄﻮات أﺳﺎﺳﻴﺔ ﻟﻠﺘﻨﻔﻴﺬ ﻓﻲ اﻟﻤﺪى اﻟﻘﺮﻳﺐ ﺑﺎﺗﺠﺎﻩ ﺗﺤﻘﻴﻖ ﺗﻠﻚ اﻷهﺪاف‬
‫اﻷﺳﺎﺳﻴﺔ ‪ .‬وﻗﺪ ﻧﺘﺞ ﻋﻦ ﻣﺠﻤﻮع اﻷﻓﻜﺎر ﺗﺼﻨﻴﻒ ﺷﺎﻣﻞ ﻟﻤﻜﺎﻓﺤﺔ ورﻋﺎﻳﺔ ﻣﺮﺿﻰ اﻟﺴﺮﻃﺎن ‪ ) .‬ﺷﻜﻞ ‪( 1‬‬
‫وآﻨﺘﻴﺠﺔ ﻟﻠﻨﻬﺞ اﻟﻌﻤﻠﻲ اﻟﻤﻨﻈﻢ ﺗﻢ اﻟﺘﻮﺻﻞ إﻟﻰ إﺟﻤﺎع ﻓﻲ اﻟﺮأي ﺑﻴﻦ اﻟﻤﺸﺮﻓﻴﻦ ﻋﻠﻰ ﻟﺠﺎن اﻟﻌﻤﻞ واﻟﺨﺒﺮاء اﻟﺪوﻟﻴﻴﻦ ﻟﺘﺒﻨﻰ " ﺑﻴﺎن اﻟﻌﺎﻟﻢ‬
‫اﻟﻌﺮﺑﻲ ﻟﻤﺮض اﻟﺴﺮﻃﺎن" ﻋﻦ ﻃﺮﻳﻖ اﺳﺘﺨﺪام ﻧﻬﺞ ﻣﻨﻈﻢ ﻋﻤﻠﻲ ﻟﺘﺤﻘﻴﻖ أهﺪاف أﺳﺎﺳﻴﺔ ﻣﺤﺪدة ﺑﺤﻠﻮل ﻋﺎم ‪. 2020‬‬
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‫آﻤﺎ ﻳﻮد ﺧﺒﺮاء ﻣﺠﻤﻮﻋﺎت اﻟﻌﻤﻞ اﻟﺘﻨﻮﻳﻪ إﻟﻰ إﺗﺨﺎذ اﻟﺒﻴﺎن اﻟﻌﺎﻟﻤﻲ ﻟﻠﺴﺮﻃﺎن )اﻻﺗﺤﺎد اﻟﺪوﻟﻲ ﻟﻤﻜﺎﻓﺤﺔ اﻟﺴﺮﻃﺎن ‪ ( 2006‬و)‬
‫اﻻﺳﺘﺮاﺗﻴﺠﻴﺔ اﻹﻗﻠﻴﻤﻴﺔ ﻟﻠﻮﻗﺎﻳﺔ وﻣﻜﺎﻓﺤﺔ اﻟﺴﺮﻃﺎن ‪ ) ( 2013 – 2009‬ﻣﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ ‪ ( 2008 ،‬آﻤﺼﺎدر أﺳﺎﺳﻴﺔ ﻟﺘﻄﻮﻳﺮ‬
‫هﺬﻩ اﻟﻤﺒﺎدرة ‪.‬‬
‫ﺷﻜﻞ ‪ . 1‬ﺗﺼﻨﻴﻒ اﻟﺮﻋﺎﻳﺔ اﻟﺸﺎﻣﻠﺔ ﻟﻤﺮﺿﻰ اﻟﺴﺮﻃﺎن وﻣﻜﺎﻓﺤﺘﻪ ﺑﺎﻟﻌﺎﻟﻢ اﻟﻌﺮﺑﻲ‬

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‫‪Initiative to Improve Cancer Care in the Arab World ‬‬ ‫‪ ‬‬ ‫‪22 ‬‬ ‫‪ ‬‬

‫اﻷهﺪاف اﻷﺳﺎﺳﻴﺔ ﻟﻌﺎم ‪ 2020‬وﺧﻄﻮات اﻟﻌﻤﻞ اﻟﺮﺋﻴﺴﻴﺔ‬
‫)ﺳﻴﺎﺳﺔ اﻟﻌﻤﻞ ( إﻗﺎﻣﺔ ﺑﺮﻧﺎﻣﺞ وﻃﻨﻲ ﻟﻤﻜﺎﻓﺤﺔ اﻟﺴﺮﻃﺎن ﻓﻲ آﻞ دوﻟﺔ‬ ‫اﻟﻬﺪف اﻷول ‪:‬‬
‫ﺧﻄﻮات اﻟﻌﻤﻞ ‪:‬‬

‫‪ .a‬إﻧﺸﺎء ﻟﺠﻨﺔ ﻋﺮﺑﻴﺔ ﻣﺸﺘﺮآﺔ اﺳﺘﺸﺎرﻳﺔ ﻟﻤﻜﺎﻓﺤﺔ اﻟﺴﺮﻃﺎن‬
‫‪ .b‬إﻧﺸﺎء ﻟﺠﻨﺔ وﻃﻨﻴﺔ ﻟﻤﻜﺎﻓﺤﺔ اﻟﺴﺮﻃﺎن ﻓﻲ آﻞ ﺑﻠﺪ ﻋﺮﺑﻲ ‪ .‬‬
‫‪ .c‬ﺗﻄﺒﻴﻖ اﺳﺘﺮاﺗﻴﺠﻴﺔ ﻣﻜﺎﻓﺤﺔ اﻟﺴﺮﻃﺎن اﻟﺘﺎﺑﻊ ﻟﻤﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ ‪ ‬‬
‫‪ .d‬ﺗﻄﻮﻳﺮ ‪ /‬ﻣﺮاﺟﻌﺔ اﻟﺨﻄﺔ اﻟﻮﻃﻨﻴﺔ ﻟﻤﻜﺎﻓﺤﺔ اﻟﺴﺮﻃﺎن وﻓﻘﺎ ﻻﺳﺘﺮاﺗﻴﺠﻴﺔ ﻣﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ اﻹﻗﻠﻴﻤﻴﺔ ﻟﻤﻜﺎﻓﺤﺔ‬
‫اﻟﺴﺮﻃﺎن ‪ .‬‬
‫‪ .e‬إﻧﺸﺎء ﻗﺎﻋﺪة ﺑﻴﺎﻧﺎت ﻟﻤﻜﺎﻓﺤﺔ اﻟﺴﺮﻃﺎن ) اﻟﻤﺆﺳﺴﺎت اﻟﻤﻌﻨﻴﺔ ( ﺑﻜﻞ دوﻟﺔ ‪ .‬‬
‫) اﻟﺘﻤﻮﻳﻞ ( إﻧﺸﺎء اﺳﺘﺮاﺗﻴﺠﻴﺎت ﻣﺴﺘﺪاﻣﺔ وﻣﻮﺛﻮق ﺑﻬﺎ ﻟﻠﺘﻤﻮﻳﻞ ﻓﻲ آﻞ دوﻟﺔ ‪ ،‬واﺳﺘﺨﺪام ﻧﻤﺎذج‬ ‫اﻟﻬﺪف اﻟﺜﺎﻧﻲ ‪:‬‬
‫ﻗﺎﺋﻤﺔ وﻓﻌﺎﻟﺔ ﻟﻠﺘﻤﻮﻳﻞ وﻣﺼﻤﻤﺔ ﺧﺼﻴﺼﺎ ﻟﺘﻔﻲ ﺑﺎﺣﺘﻴﺎﺟﺎت وﻗﺪرات ﺗﻠﻚ اﻟﺪوﻟﺔ ‪.‬‬

‫‪ .a‬اﻟﺘﻌﺎون ﻣﻊ اﻟﻤﻨﻈﻤﺎت اﻟﺨﻴﺮﻳﺔ ﻏﻴﺮ اﻟﺤﻜﻮﻣﻴﺔ ‪.‬‬
‫‪ .b‬ﺗﻘﺪﻳﻢ ﺗﺪرﻳﺐ ‪ /‬ﺗﻌﻠﻴﻢ ﻓﻲ إدارة اﻟﺘﻤﻮﻳﻞ ‪ .‬‬
‫‪ .c‬اﺳﺘﺨﺪام ﻧﻤﺎذج اﻗﻠﻴﻤﻴﺔ ودوﻟﻴﺔ ﻣﺘﺎﺣﺔ ﻟﻠﺘﻤﻮﻳﻞ ‪ .‬‬
‫) اﻟﻜﺸﻒ اﻟﻤﺒﻜﺮ واﻟﻮﻗﺎﻳﺔ ( إﻧﺸﺎء ﺑﺮاﻣﺞ ﻣﺘﺎﺣﺔ وﻓﻌﺎﻟﺔ ﻟﻠﻜﺸﻒ اﻟﻤﺒﻜﺮ ﻋﻦ اﻟﺴﺮﻃﺎن ﻓﻲ آﻞ‬ ‫اﻟﻬﺪف اﻟﺜﺎﻟﺚ ‪:‬‬
‫دوﻟﺔ‬

‫إﻧﺸﺎء ﻟﺠﻨﺔ ﺗﻮﺟﻴﻪ ﻣﺮآﺰﻳﺔ ﻣﻊ ﻣﻤﺜﻠﻴﻦ ﻣﻦ آﻞ دوﻟﺔ ﻣﺸﺎرآﺔ‬ ‫‪.1‬‬
‫ﺗﻄﻮﻳﺮ ﺑﺮاﻣﺞ ﺗﺪرﻳﺒﻴﺔ ﻷﻃﺒﺎء اﻟﺮﻋﺎﻳﺔ اﻷوﻟﻴﺔ واﻟﻤﺨﺘﺼﻴﻦ ﺑﺎﻟﺮﻋﺎﻳﺔ اﻟﺼﺤﻴﺔ اﻷﺧﺮى ‪ .‬‬ ‫‪.2‬‬
‫ﺗﻄﻮﻳﺮ ﺧﻄﻂ ﻣﻮﺣﺪة ﻟﻤﺮآﺰ اﻟﺴﺮﻃﺎن ﻟﻠﺘﺸﺨﻴﺺ واﻟﻜﺸﻒ اﻟﻤﺒﻜﺮ ‪ .‬‬ ‫‪.3‬‬
‫ﺗﺤﺪﻳﺪ ﺧﺪﻣﺎت اﻟﻜﺸﻒ اﻟﻤﺒﻜﺮ اﻟﻤﻮﺟﻮدة وﻣﺮاﺟﻌﺘﻬﺎ‪ ، ‬ﺛﻢ اﻧﺸﺎء ﺑﻨﻴﺔ ﺗﺤﺘﻴﺔ ﻳﻤﻜﻦ اﻻﻋﺘﻤﺎد ﻋﻠﻴﻬﺎ ﻟﻔﺤﺺ‬ ‫‪.4‬‬
‫ﺳﺮﻃﺎﻧﺎت ﻣﻌﻴﻨﺔ ‪ .‬‬
‫اﺗﺒﺎع ﻣﻌﺎﻳﻴﺮ اﺧﺘﻴﺎرﻳﺔ ﻣﻮﺣﺪة ﻟﻠﻜﺸﻒ ﻋﻦ اﻟﺴﺮﻃﺎن ‪ .‬‬ ‫‪.5‬‬
‫زﻳﺎدة اﻟﺠﻬﻮد ﻟﻠﺤﺪ ﻣﻦ اﻟﺴﻤﻨﺔ وﺗﺤﺴﻴﻦ اﻟﺘﻐﺬﻳﺔ وﻧﻤﻂ اﻟﺤﻴﺎة ) اﻟﻨﺸﺎط اﻟﺒﺪﻧﻲ ( ‪ ‬‬ ‫‪.6‬‬
‫) ﻣﻜﺎﻓﺤﺔ اﻟﺘﺪﺧﻴﻦ ( ﺗﺨﻔﻴﺾ ﻣﻌﺪﻻت اﺳﺘﻬﻼك آﻞ أﺷﻜﺎل اﻟﺘﺒﻎ ﻓﻲ اﻟﺪول اﻟﻌﺮﺑﻴﺔ آﺎﻓﺔ ‪.‬‬ ‫اﻟﻬﺪف اﻟﺮاﺑﻊ ‪:‬‬

‫‪ .a‬ﺗﻜﺜﻴﻒ ﺣﻤﻼت ﺗﻮﻋﻴﺔ اﻟﺸﻌﻮب ﻋﻦ ﻃﺮﻳﻖ وﺳﺎﺋﻞ اﻻﻋﻼم اﻟﻌﺎﻣﺔ وﺑﺮاﻣﺞ ﺗﻌﻠﻴﻢ اﻟﻤﺠﻤﺘﻊ ‪.‬‬
‫‪ .b‬دﻋﻢ اﻧﻔﺎذ ﺗﺸﺮﻳﻌﺎت ﻟﻤﻜﺎﻓﺤﺔ اﻟﺘﺪﺧﻴﻦ ﻋﻠﻰ ﺳﺒﻴﻞ اﻟﻤﺜﺎل ﻣﻨﻊ اﻟﺘﺪﺧﻴﻦ ﻓﻲ اﻷﻣﺎآﻦ اﻟﻌﺎﻣﺔ ‪ ،‬وﺗﺤﺪﻳﺪ ﻋﻤﺮ آﺤﺪ‬
‫ادﻧﻰ ﻟﻠﺘﺪﺧﻴﻦ ‪ .‬‬
‫‪ .c‬ﺗﺄﻳﻴﺪ ﺗﺸﺮﻳﻌﺎت زﻳﺎدة اﻟﻀﺮاﺋﺐ ﻋﻠﻰ ﺷﺮآﺎت اﻟﺘﺒﻎ وﺗﺨﺼﻴﺺ ﻋﺎﺋﺪات ﺗﻠﻚ اﻟﻀﺮاﺋﺐ ﻷﺑﺤﺎث اﻟﺴﺮﻃﺎن‬
‫اﻟﻬﺪف اﻟﺨﺎﻣﺲ ‪ ) :‬اﻟﻤﻮارد اﻟﺒﺸﺮﻳﺔ ( ﺗﺤﺴﻴﻦ ﻗﺪارت اﻟﻤﻮارد اﻟﺒﺸﺮﻳﺔ ﻓﻲ آﻞ اﻟﻤﻬﻦ ذات اﻟﺼﻠﺔ ﺑﺮﻋﺎﻳﺔ‬
‫ﻣﺮﺿﻰ اﻟﺴﺮﻃﺎن اﻟﺸﺎﻣﻠﺔ‬
‫ﺧﻄﻮات اﻟﻌﻤﻞ‪:‬‬

‫زﻳﺎدة ﻋﺪد اﻟﺒﺮاﻣﺞ اﻷآﺎدﻳﻤﻴﺔ ﻟﻤﺨﺘﻠﻒ اﻟﺘﺨﺼﺼﺎت ذات اﻟﺼﻠﺔ ﺑﺮﻋﺎﻳﺔ ﻣﺮﺿﻰ اﻟﺴﺮﻃﺎن ‪.‬‬ ‫‪.a‬‬
‫إﻧﺸﺎء ﺑﺮاﻣﺞ ﻟﻠﺘﻌﻠﻴﻢ اﻟﻤﺴﺘﻤﺮ واﻟﺘﺪرﻳﺐ واﻟﺘﻄﻮﻳﺮ ﻟﻠﻤﻤﺎرﺳﻴﻦ اﻟﻤﺘﺨﺼﺼﻴﻦ ‪ .‬‬ ‫‪.b‬‬
‫ﺗﺤﺴﻴﻦ ﻣﻌﺎﻳﻴﺮ اﻟﻤﻤﺎرﺳﺔ ﻟﺪﻋﻢ اﻻآﺘﻔﺎء اﻟﻤﻬﻨﻲ وﺗﻮﻇﻴﻒ اﻟﻌﺎﻣﻠﻴﻦ واﻻﺣﺘﻔﺎظ ﺑﻬﻢ واﻟﺘﻲ ﺗﺆدي ﻧﻬﺎﻳﺔ إﻟﻰ ﺗﺤﺴﻴﻦ‬ ‫‪.c‬‬
‫اﻟﻌﻨﺎﻳﺔ ﺑﻤﺮﺿﻰ اﻟﺴﺮﻃﺎن ‪ .‬‬
‫ﺗﺤﺴﻴﻦ وﻋﻲ اﻟﻤﺨﺘﺼﻴﻦ واﻷآﺎدﻳﻤﻴﻴﻦ واﻟﻤﺠﺘﻤﻊ ﻋﻦ اﻟﺤﺎﺟﺔ اﻟﻤﺎﺳﺔ إﻟﻰ ﻣﺨﺘﺼﻴﻦ ﻣﺆهﻠﻴﻦ ﻟﺮﻋﺎﻳﺔ ﻣﺮﺿﻰ‬ ‫‪.d‬‬
‫اﻟﺴﺮﻃﺎن وﻗﻴﻤﺔ ﻣﺎ ﻳﻘﺪﻣﻮﻧﻪ ﻣﻦ آﻔﺎءة ﻟﺘﺤﺴﻴﻦ اﻟﻌﻨﺎﻳﺔ ﺑﻤﺮﺿﻰ اﻟﺴﺮﻃﺎن ‪ .‬‬
‫اﻟﻬﺪف اﻟﺴﺎدس ‪) :‬اﻟﺴﺠﻼت واﻟﺒﻴﺎﻧﺎت (إﻧﺸﺎء ﺷﺒﻜﺔ ﻋﺮﺑﻴﺔ ﺁﻟﻴﺔ ﻟﺴﺠﻞ اﻟﺴﺮﻃﺎن واﻟﺘﻲ ﺗﺘﻤﺎﺷﻰ ﻣﻊ اﻟﻤﻌﺎﻳﻴﺮ‬
‫اﻟﺪوﻟﻴﺔ‬

‫‪ -1‬إﻧﺸﺎء ﻟﺠﻨﺔ ﺗﻮﺟﻴﻪ ﻣﺮآﺰﻳﺔ‬
‫‪ -2‬ﺗﻄﻮﻳﺮ اﻟﻤﻌﺎﻳﻴﺮ اﻹﻗﻠﻴﻤﻴﺔ ﻟﺒﻴﺎﻧﺎت ﻣﺮض اﻟﺴﺮﻃﺎن ‪ .‬‬
‫‪ -3‬ﺗﺤﺪﻳﺪ اﻟﺤﺪ اﻷدﻧﻰ اﻟﻼزم ﻟﻠﻤﺸﺎرآﺔ ﻓﻲ اﻟﺒﻴﺎﻧﺎت ‪ .‬‬
‫‪ -4‬إﻧﺸﺎء ﺁﻟﻴﺔ ﻟﻠﺸﺒﻜﺎت وﻧﻘﻞ اﻟﺒﻴﺎﻧﺎت ‪ .‬‬
‫‪ -5‬إﻧﺸﺎء ﻣﻌﺎﻳﻴﺮ ﻟﻺﺑﻼغ ﻋﻦ اﻟﺒﻴﺎﻧﺎت واﺳﺘﺨﺪاﻣﻬﺎ ‪ .‬‬
‫‪ -6‬إﻧﺸﺎء ﺁﻟﻴﺎت ﻟﻠﺘﺒﻠﻴﻎ ﻋﻦ اﻟﺤﺎﻻت وﻣﺮاﻗﺒﺘﻬﺎ وﻣﺘﺎﺑﻌﺎﺗﻬﺎ ‪ ‬‬
‫) اﻷﺑﺤﺎث ( ﺑﺪء وﺗﻨﻔﻴﺬ أﻧﺸﻄﺔ ﺗﻌﺎوﻧﻴﺔ ﻓﻲ ﻣﺠﺎل أﺑﺤﺎث اﻟﺴﺮﻃﺎن وﺗﻨﻔﻴﺬهﺎ ﺑﺪﻗﺔ ﻓﻲ آﺎﻓﺔ‬ ‫اﻟﻬﺪف اﻟﺴﺎﺑﻊ ‪:‬‬
‫اﻟﺪول اﻟﻌﺮﺑﻴﺔ وذﻟﻚ ﻃﺒﻘﺎ ﻟﺘﻮﻓﺮ اﻟﻤﻮارد‬

‫‪ -1‬إﻧﺸﺎء ﻟﺠﻨﺔ ﺗﻮﺟﻴﻬﻴﺔ ﻋﺮﺑﻴﺔ ﻷﺑﺤﺎث اﻟﺴﺮﻃﺎن ‪.‬‬
‫‪ -2‬ﺗﺸﺠﻴﻊ اﻟﻤﺸﺎرآﺔ اﻟﻨﺸﻄﺔ ﻣﻦ ﺟﺎﻧﺐ أﻃﺒﺎء اﻷورام ﻓﻲ اﻟﺘﺠﺎرب اﻟﺴﺮﻳﺮﻳﺔ واﻟﺒﺤﻮث اﻷﺧﺮى ذات اﻟﺼﻠﺔ ‪ .‬‬
‫‪ -3‬وﺿﻊ ﺑﺮاﻣﺞ ﺗﺪرﻳﺐ ﻟﻠﺒﺎﺣﺜﻴﻦ ﻓﻲ اﻟﻤﻨﻄﻘﺔ اﻟﻌﺮﺑﻴﺔ ‪ .‬‬
‫‪ -4‬إﻧﺸﺎء ﺷﺒﻜﺔ ﻣﺸﺘﺮآﺔ ﻋﺮﺑﻴﺔ ﻟﻸﺑﺤﺎث ‪ .‬‬
‫‪ -5‬اﻟﺘﺸﺠﻴﻊ ﻋﻠﻰ ﺗﺮﺟﻤﺔ اﻟﻨﺘﺎﺋﺞ اﻟﺒﺤﺜﻴﺔ إﻟﻰ اﻟﻤﻤﺎرﺳﺔ اﻟﺴﺮﻳﺮﻳﺔ آﻤﺎ هﻮ ﻣﻨﺎﺳﺐ ﻟﻜﻞ ﺑﻠﺪ‪ .‬‬
‫‪ -6‬إﻧﺸﺎء ﻣﺮاآﺰ ‪ /‬ﺑﺮاﻣﺞ ﻓﻲ اﻟﻤﻨﻄﻘﺔ ﻣﺨﺘﺼﺔ ﺑﺄﺑﺤﺎث ﺗﻘﻴﻴﻢ اﻟﻨﺘﺎﺋﺞ واﻟﻔﺎﻋﻠﻴﺔ ﻟﺮﻋﺎﻳﺔ ﻣﺮﺿﻰ اﻟﺴﺮﻃﺎن ‪.‬‬
‫) اﻹرﺷﺎدات ( اﻟﺘﺄآﺪ ﻣﻦ أن ﻣﻌﺎﻳﻴﺮ اﻟﻤﻤﺎرﺳﺔ واﻟﺮﻋﺎﻳﺔ اﻟﻤﻘﺪﻣﺔ ﻟﻐﺎﻟﺒﻴﺔ ﻣﺮﺿﻰ اﻟﺴﺮﻃﺎن ﻓﻲ‬ ‫اﻟﻬﺪف اﻟﺜﺎﻣﻦ‪:‬‬
‫اﻟﺪول اﻟﻌﺮﺑﻴﺔ ﻣﻌﺘﻤﺪة ﻋﻠﻰ اﻹرﺷﺎدات اﻟﻤﺴﺘﻤﺪة ﻣﻦ اﻟﺒﺮاهﻴﻦ‬

‫‪ .a‬إﻧﺸﺎء ﻟﺠﻨﺔ ﺗﻮﺟﻴﻬﻴﺔ إﻗﻠﻴﻤﻴﺔ ﻣﺘﻌﺪدة اﻟﺘﺨﺼﺼﺎت ‪.‬‬
‫‪ .b‬إﻋﺘﻤﺎد اﻹرﺷﺎدات اﻟﺘﻮﺟﻴﻬﻴﺔ اﻟﻤﻘﺒﻮﻟﺔ ﺣﺎﻟﻴﺎ ﻟﺘﻠﺒﻴﺔ اﻟﺘﻮﻗﻌﺎت اﻟﺜﻘﺎﻓﻴﺔ واﻟﻤﻮارد اﻟﻤﺘﺎﺣﺔ ‪ .‬‬
‫‪ .c‬ﺗﻌﺪﻳﻞ اﻹرﺷﺎدات اﻟﺘﻮﺟﻴﻬﻴﺔ اﻟﻘﺎﺋﻤﺔ ﺑﻨﺎء ﻋﻠﻰ اﻷدﻟﺔ واﻟﺒﺮاهﻴﻦ اﻟﻤﻨﺒﺜﻘﺔ ﻣﻦ اﻟﻤﻨﻄﻘﺔ ‪ .‬‬
‫‪ .d‬إﻧﺸﺎء أﻧﻈﻤﺔ ﻣﺴﺘﺪاﻣﺔ وﻓﻌﺎﻟﺔ ﻟﺮﺻﺪ وﺗﻘﻴﻴﻢ اﻟﻨﺘﺎﺋﺞ ‪ .‬‬
‫) اﻟﺘﺸﺨﻴﺺ ( اﻟﺘﺄآﺪ ﻣﻦ اﺗﺒﺎع اﻟﻤﻌﺎﻳﻴﺮ اﻟﻌﺎﻟﻤﻴﺔ وأﻧﻈﻤﺔ ﻣﺮاﻗﺒﺔ اﻟﺠﻮدة ﻓﻲ آﺎﻓﺔ اﺧﺘﺒﺎرات‬ ‫اﻟﻬﺪف اﻟﺘﺎﺳﻊ ‪:‬‬
‫ﺗﺸﺨﻴﺺ اﻟﺴﺮﻃﺎن ﻓﻲ اﻟﻌﺎﻟﻢ اﻟﻌﺮﺑﻲ‬
‫ﺧﻄﻮات اﻟﻌﻤﻞ‪:‬‬
‫‪ .a‬إﻧﺸﺎء ﻟﺠﻨﺔ ﺗﻮﺟﻴﻬﻴﺔ إﻗﻠﻴﻤﻴﺔ ﻟﻺﺷﺮاف ﻋﻠﻰ ﺗﻨﻈﻴﻢ وﺗﻄﻮﻳﺮ وﺗﻨﻔﻴﺬ ﻣﻌﺎﻳﻴﺮ اﻟﺘﺸﺨﻴﺺ ‪.‬‬
‫‪ .b‬وﺿﻊ ﻣﺒﺎدئ ﺗﻮﺟﻴﻬﻴﺔ وإرﺷﺎدات ﻟﻠﺘﻄﺒﻴﻖ اﻟﺴﺮﻳﺮي ﻣﻦ ﻗﺒﻞ اﻷﻃﺒﺎءاﻷوﻟﻴﻴﻦ وإﺧﺼﺎﺋﻴﻴﻦ اﻷﺷﻌﺔ ‪ .‬‬
‫‪ .c‬ﺗﻄﻮﻳﺮ ﻣﺮاآﺰ ﻣﺮﺟﻌﻴﺔ وﻃﻨﻴﺔ ﻟﺘﺸﺨﻴﺺ اﻟﺴﺮﻃﺎن ‪ ‬‬
‫‪ .d‬وﺿﻊ إﺟﺮاءات ﻓﻲ ﻣﺮاآﺰ اﻟﺴﺮﻃﺎن ﺣﻴﺚ ﺗﺮاﺟﻊ اﻟﺤﺎﻻت اﻟﻤﻌﻘﺪة ) ﻣﺜﻞ ﺗﺸﺨﻴﺺ ﺣﺎﻟﺔ ﻏﻴﺮ ﻋﺎدﻳﺔ أو ﻓﺸﻞ ﻓﻲ‬
‫اﺳﺘﺠﺎﺑﺔ ﻟﻠﻌﻼج ( وﺗُﻨﺎﻗﺶ ﻣﻦ ﻗِﺒﻞ ﻓﺮﻳﻖ ﻣﺘﻌﺪد اﻟﺘﺨﺼﺼﺎت ﻣﻤﺎ ﻳﻨﺘﺞ ﻋﻨﻪ ﺧﻄﺔ ﻣﻜﺘﻮﺑﺔ ﻟﻠﺮﻋﺎﻳﺔ‪ .‬‬

‫) اﻟﻮﺻﻮل إﻟﻰ اﻟﻤﺮاﻓﻖ ( ﺗﺤﺪﻳﺪ ﻃﺒﻴﻌﺔ ﻋﺪم اﻟﻤﺴﺎواة ﻓﻲ اﻟﻤﺮاﻓﻖ اﻟﺼﺤﻴﺔ وﻓﻲ ﺗﻘﺪﻳﻢ‬ ‫اﻟﻬﺪف اﻟﻌﺎﺷﺮ ‪:‬‬
‫ﺧﺪﻣﺎت آﺸﻒ اﻟﺴﺮﻃﺎن واﻟﺮﻋﺎﻳﺔ اﻟﺼﺤﻴﺔ اﻟﻌﺮﺑﻴﺔ وﺗﺨﺼﻴﺺ اﻟﻤﻮارد‬

‫‪ -1‬ﺗﻜﻮﻳﻦ ﻓﺮﻳﻖ ﻣﻦ اﻟﺨﺒﺮاء ﻓﻲ هﺬا اﻟﻤﺠﺎل ﻟﺘﻘﺪﻳﻢ ﺗﻮﺻﻴﺎت ﻣﻦ أﺟﻞ ﺗﺤﺪﻳﺪ اﻷوﻟﻮﻳﺎت وﺗﺨﺼﻴﺺ اﻟﻤﻮارد ﻓﻲ‬
‫آﻞ ﻗُﻄﺮ‪.‬‬
‫‪ -2‬ﻋﻤﻞ ﺣﺼﺮ ﻟﺠﻤﻴﻊ ﻣﺮاﻓﻖ رﻋﺎﻳﺔ ﻣﺮﺿﻰ اﻟﺴﺮﻃﺎن ﻓﻲ آﻞ ﺑﻠﺪ ‪ .‬‬
‫‪. -3‬إﻧﺸﺎء ﻣﻌﺎﻳﻴﺮ ﻟﺘﻘﺪﻳﻢ رﻋﺎﻳﺔ ﻟﻤﺮﺿﻰ اﻟﺴﺮﻃﺎن ﻓﻲ آﺎﻓﺔ ﻣﺴﺘﻮﻳﺎت ﻣﺮاآﺰ اﻟﺮﻋﺎﻳﺔ اﻟﺼﺤﻴﺔ اﻷوﻟﻴﺔ واﻟﺜﺎﻧﻮﻳﺔ‬
‫واﻟﺘﺨﺼﺼﻴﺔ إﻋﺘﻤﺎداﻋﻠﻰ اﻟﺤﺎﺟﺔ اﻟﺴﻜﺎﻧﻴﺔ واﻟﺠﻐﺮاﻓﻴﺔ وﺗﺮآﺰ اﻟﻤﺮض‪ .‬‬
‫‪ -4‬ﺗﺤﺪﻳﺪ ﻃﺮﻳﻘﺔ ﻣﻨﺎﺳﺒﺔ ﻟﺘﺨﺼﻴﺺ اﻟﻤﻮارد ﻟﺘﺤﺴﻴﻦ اﻟﻮﺻﻮل إﻟﻰ اﻟﻤﺮاﻓﻖ ﻓﻲ آﻞ دوﻟﺔ ﻋﻠﻰ أﺳﺎس هﺬﻩ اﻟﻤﻌﺎﻳﻴﺮ‪ .‬‬
‫) اﻟﺤﺼﻮل ﻋﻠﻰ اﻟﺪواء ( اﻟﺘﺄآﺪ ﻣﻦ ﺗﻮﻓﺮ أدوﻳﺔ ﻣﺮﺿﻰ اﻟﺴﺮﻃﺎن ﺑﻨﺎء ﻋﻠﻰ دراﺳﺔ‬ ‫اﻟﻬﺪف اﻟﺤﺎدي ﻋﺸﺮ ‪:‬‬
‫واﻓﻴﺔ ﺗﻄﺒﻖ ﻋﻠﻰ أﺳﺲ ﻋﻠﻤﻴﺔ‬
‫ﺧﻄﻮات اﻟﻌﻤﻞ ‪ :‬‬

‫‪ .a‬اﻟﻘﻴﺎم ﺑﻌﻤﻞ دراﺳﺔ ﺗﺤﻠﻴﻠﻴﺔ ﻋﻦ وﺿﻊ‪ ‬ﺗﻮﻓﺮ أدوﻳﺔ اﻟﺴﺮﻃﺎن ﻟﻠﻤﺮﺿﻰ ‪.‬‬
‫‪ .b‬ﺗﻮﻓﻴﺮ ﺗﻤﻮﻳﻞ آﺎﻓﻲ ﻟﻠﺤﺼﻮل ﻋﻠﻰ ﻋﻼج ﻣﺮض اﻟﺴﺮﻃﺎن ‪ .‬‬
‫‪ .c‬اﻟﺘﺄآﺪ ﻣﻦ وﺟﻮد ﺳﻴﺎﺳﺎت ﺻﺤﻴﺔ ﺗﻌﺎﻟﺞ ﻣﺴﺄﻟﺔ اﻟﺤﺼﻮل ﻋﻠﻰ أدوﻳﺔ اﻟﺴﺮﻃﺎن ‪ .‬‬
‫‪ .d‬إﻧﺸﺎء وﺗﻨﻔﻴﺬ ﺑﺮﻧﺎﻣﺞ ﺗﺒﺎدل اﻟﺨﺒﺮات اﻟﺪوﻟﻴﺔ واﻹﻗﻠﻴﻤﻴﺔ ‪ .‬‬
‫) اﻟﺮﻋﺎﻳﺔ اﻟﺘﻠﻄﻴﻔﻴﺔ ( ﺗﻌﺰﻳﺰ اﻟﺘﻜﺎﻣﻞ ﻟﻠﺮﻋﺎﻳﺔ اﻟﺸﺎﻣﻠﺔ اﻟﺘﻠﻄﻴﻔﻴﺔ ﻟﺠﻤﻴﻊ ﻣﺮﺿﻰ‬ ‫اﻟﻬﺪف اﻟﺜﺎﻧﻲ ﻋﺸﺮ ‪:‬‬
‫اﻟﺴﺮﻃﺎن ﻋﻠﻰ ﻣﺴﺘﻮى اﻟﻌﺎﻟﻢ اﻟﻌﺮﺑﻲ ‪ .‬‬
‫ﺧﻄﻮات اﻟﻌﻤﻞ ‪ :‬‬

‫‪ .a‬زﻳﺎدة اﻟﻮﻋﻲ ﺑﺎﻟﺮﻋﺎﻳﺔ اﻟﺘﻠﻄﻴﻔﻴﺔ ﻋﺒﺮ اﻟﺘﻮاﺻﻞ وﺗﺄﻳﻴﺪ اﻟﻤﻬﺘﻤﻴﻦ ﺑﻬﺬا اﻟﻤﺠﺎل‪.‬‬
‫‪ .b‬ﺗﺤﺪﻳﺪ ﻧﻘﺎط اﻟﻀﻌﻒ واﻻﺣﺘﻴﺎﺟﺎت واﻟﻤﻮارد اﻟﻤﺘﻮﻓﺮة ﻟﻠﺮﻋﺎﻳﺔ اﻟﺘﻠﻄﻴﻔﻴﺔ ﻓﻲ اﻟﻌﺎﻟﻢ اﻟﻌﺮﺑﻲ ‪ .‬‬
‫‪ .c‬دﻋﻢ ﺗﻄﻮﻳﺮ وﺿﻊ ﺧﻄﺔ اﺳﺘﺮاﺗﻴﺠﻴﺔ ﻟﻠﺮﻋﺎﻳﺔ اﻟﺘﻠﻄﻴﻔﻴﺔ ﺧﺎص ﻟﻜﻞ ﺑﻠﺪ ‪ .‬‬
‫‪ .d‬دﻋﻢ ﺗﺤﻮﻳﺮ وﺗﻜﺎﻣﻞ ﻣﻨﻬﺞ اﻟﺮﻋﺎﻳﺔ اﻟﺘﻠﻄﻴﻔﻴﺔ ﻣﻊ اﻟﻤﻨﺎهﺞ اﻟﻘﺎﺋﻤﺔ ﻟﺠﻤﻴﻊ ﻣﻘﺪﻣﻰ اﻟﺮﻋﺎﻳﺔ اﻟﺼﺤﻴﺔ ﻋﻠﻰ ﺟﻤﻴﻊ‬
‫اﻟﻤﺴﺘﻮﻳﺎت ‪ .‬‬
‫‪ .e‬إﻧﺸﺎء ﺑﺮاﻣﺞ ﺗﺪرﻳﺒﻴﺔ ﻣﺨﺘﺼﺔ ﺑﺎﻟﺮﻋﺎﻳﺔ اﻟﺘﻠﻄﻴﻔﻴﺔ ﻣﻦ اﻟﻌﻨﺎﻳﺔ اﻷوﻟﻴﺔ ووﺻﻮﻻ إﻟﻰ اﻟﻤﺴﺘﻮﻳﺎت اﻟﻤﺘﺨﺼﺼﺔ ‪ .‬‬
‫‪ .f‬دﻋﻢ ﺗﻮاﻓﺮ وإﻣﻜﺎﻧﻴﺔ اﻟﺤﺼﻮل ﻋﻠﻰ اﻷدوﻳﺔ اﻷﺳﺎﺳﻴﺔ واﻷدوﻳﺔ اﻟﻤﺴﻜﻨﺔ ﻟﺠﻤﻴﻊ ﻣﺮﺿﻰ اﻟﺴﺮﻃﺎن ‪ .‬‬
‫‪ .g‬دﻋﻢ ﺗﻄﻮﻳﺮ ﺧﺪﻣﺎت اﻟﺮﻋﺎﻳﺔ اﻟﺘﻠﻄﻴﻔﻴﺔ ﻋﻠﻰ ﺟﻤﻴﻊ ﻣﺴﺘﻮﻳﺎت اﻟﺮﻋﺎﻳﺔ وﺑﻤﺎ ﻓﻲ ذﻟﻚ اﻟﺨﺪﻣﺎت اﻟﻤﺠﺘﻤﻌﻴﺔ ﻟﻜﺎﻓﺔ‬
‫اﻷﻋﻤﺎر ‪ .‬‬
‫‪ .h‬إﻧﺸﺎء وﺗﻨﻔﻴﺬ ﻣﻌﺎﻳﻴﺮ اﻟﺮﻋﺎﻳﺔ اﻟﺘﻠﻄﻴﻔﻴﺔ وﺗﻘﻴﻴﻤﻬﺎ ﻣﻦ ﺧﻼل اﻟﺘﺄﻳﻴﺪ ‪ ،‬وﺗﻮﻓﻴﺮ اﻟﺨﺪﻣﺎت واﻟﺘﻌﻠﻴﻢ واﻟﺘﺪرﻳﺐ‬
‫واﻟﺮﺻﺪ واﻟﺒﺤﺚ ‪.‬‬
‫) أورام اﻷﻃﻔﺎل ( ﺧﻔﺾ ﻣﻌﺪﻻت اﻻﺧﺘﻼﻃﺎت واﻟﻮﻓﻴﺎت ﺑﻴﻦ اﻷﻃﻔﺎل اﻟﻤﺼﺎﺑﺔ‬ ‫اﻟﻬﺪف اﻟﺜﺎﻟﺚ ﻋﺸﺮ ‪:‬‬
‫ﺑﻤﺮض اﻟﺴﺮﻃﺎن ﻓﻲ اﻟﻌﺎﻟﻢ اﻟﻌﺮﺑﻲ ‪.‬‬

‫‪ -1‬ﺗﺸﻜﻴﻞ ﺷﺒﻜﺔ اﻗﻠﻴﻤﻴﺔ ﻟﺘﺴﻬﻴﻞ ﺗﻄﻮﻳﺮ ﺑﺮاﻣﺞ رﻋﺎﻳﺔ أﻃﻔﺎل اﻟﺴﺮﻃﺎن ﻓﻲ اﻟﻌﺎﻟﻢ اﻟﻌﺮﺑﻲ ‪ .‬‬
‫‪ -2‬ﺗﻄﻮﻳﺮ ﺑﺮﻧﺎﻣﺞ اﻟﺰﻣﺎﻟﺔ ﻷﻃﺒﺎء اﻷﻃﻔﺎل اﻟﻤﺨﺘﺼﻴﻦ ﺑﺄﻣﺮاض اﻟﺪم واﻷورام ﻳﻘﺪم ﻟﻠﻬﻴﺌﺔ اﻟﻌﺮﺑﻴﺔ واﻟﻤﺤﻠﻴﺔ‬
‫ﻟﻺﻋﺘﻤﺎد ‪ .‬‬
‫‪ -3‬إﻧﺸﺎء ﺑﺮاﻣﺞ ﺗﺪرﻳﺐ إﻗﻠﻴﻤﻴﺔ ﻟﻤﻤﺮﺿﺎت اﻷﻃﻔﺎل اﻟﻤﺨﺘﺼﻴﻦ ﺑﺄﻣﺮاض اﻟﺪم واﻷورام ﺑﻤﺎ ﻓﻲ ذﻟﻚ اﻟﻤﻤﺮﺿﺎت‬
‫اﻟﻤﺨﺘﺼﻴﻦ اﻟﻤﺘﻘﺪﻣﻴﻦ وأﻳﻀﺎ ﻣﻘﺪﻣﻲ اﻟﺮﻋﺎﻳﺔ اﻟﺘﺪﻋﻴﻤﻴﺔ ﻣﻦ اﺧﺼﺎﺋﻴﻴﻦ أورام اﻷﻃﻔﺎل ﻣﺜﻞ اﺧﺼﺎﺋﻴﻴﻦ اﻟﺘﻐﺬﻳﺔ‬
‫وأﺧﺼﺎﺋﻴﻴﻦ ﺗﺜﻘﻴﻒ اﻟﻤﺮﺿﻰ واﻟﺼﻴﺎدﻟﺔ وأﻳﻀﺎ اﻹﺧﺼﺎﺋﻴﻴﻦ اﻻﺟﺘﻤﺎﻋﻴﻴﻦ واﻹﺧﺼﺎﺋﻴﻴﻦ اﻟﻨﻔﺴﻴﻴﻦ ‪ .‬‬
‫‪ -4‬إﻧﺸﺎء ﺑﺮاﻣﺞ اﻟﺮﻋﺎﻳﺔ اﻟﺘﻠﻄﻴﻔﻴﺔ ﻟﻸﻃﻔﺎل ﻓﻲ آﻞ دوﻟﺔ ﻋﺮﺑﻴﺔ ‪ .‬‬
‫‪ -5‬إﻧﺸﺎء ﻗﺎﻋﺪة ﺑﻴﺎﻧﺎت ﻣﺤﻠﻴﺔ وإﻗﻠﻴﻤﻴﺔ ﻟﺴﺮﻃﺎن اﻷﻃﻔﺎل ‪ .‬‬
‫‪ ‬‬

‫ﻳﻤﻜﻦ ﺗﺤﻘﻴﻖ هﺬﻩ اﻷهﺪاف ﻋﻦ ﻃﺮﻳﻖ اﻟﺘﻌﺎون اﻟﻤﺸﺘﺮك ﺑﻴﻦ اﻟﻤﻨﻈﻤﺎت اﻟﺤﻜﻮﻣﻴﺔ وﻏﻴﺮ اﻟﺤﻜﻮﻣﻴﺔ واﻟﻬﻴﺌﺎت‬
‫اﻷآﺎدﻳﻤﻴﺔ واﻷﻓﺮاد اﻟﻤﻬﺘﻤﻴﻦ وأﻳﻀﺎ ﻋﻦ ﻃﺮﻳﻖ ﺗﺸﻜﻴﻞ ﺷﺮاآﺎت ﻣﻊ اﻟﻤﻨﻈﻤﺎت اﻟﺪوﻟﻴﺔ واﻟﻬﻴﺌﺎت واﻟﺨﺒﺮاء ‪ .‬‬
‫‪ ‬‬
‫ﺳﻴﺘﻢ ﺗﻘﺪﻳﻢ ﺗﻘﺮﻳﺮ آﻞ ﺛﻼﺛﺔ أﺷﻬﺮ ﺑﻨﺸﺎﻃﺎت اﻟﻠﺠﺎن إﻟﻰ اﻟﻤﺴﺆوﻟﻴﻦ ﻋﻦ " اﻟﻤﺒﺎدرة ﻟﺘﺤﺴﻴﻦ اﻟﻌﻨﺎﻳﺔ ﺑﻤﺮﺿﻰ‬
‫اﻟﺴﺮﻃﺎن ﺑﺎﻟﻌﺎﻟﻢ اﻟﻌﺮﺑﻲ "‪ ،‬آﻤﺎ ﺳﻴﺘﻢ أﻳﻀﺎ ﻋﻤﻞ ﺗﻘﺮﻳﺮ ﺳﻨﻮى ﻟﺘﻘﺪﻳﻤﻪ إﻟﻰ اﻟﺴﻠﻄﺎت ﻓﻲ اﻟﺪول اﻟﻤﺸﺎرآﺔ ‪ .‬‬
‫وﻗﻊ ﻧﻴﺎﺑﺔ ﻋﻦ اﻷﻓﺮاد واﻟﻤﻨﻈﻤﺎت اﻟﻤﺸﺎرآﺔ ﺑﺘﺎرﻳﺦ ‪2010/4/24‬‬
‫____________________________ ‪ ‬‬
‫اﻟﺪآﺘﻮر ‪ /‬ﻋﺒﺪ اﻟﺮﺣﻤﻦ ﺟﺎزﻳﺔ‬
‫رﺋﻴﺲ اﻟﻠﺠﻨﺔ اﻟﻌﻠﻤﻴﺔ ﻟﻤﺒﺎدرة ﺗﺤﺴﻴﻦ اﻟﻌﻨﺎﻳﺔ ﺑﻤﺮﺿﻰ اﻟﺴﺮﻃﺎن ﺑﺎﻟﻌﺎﻟﻢ اﻟﻌﺮﺑﻲ‬
‫____________________________‬
‫اﻟﺪآﺘﻮرة ‪ /‬أم اﻟﺨﻴﺮ أﺑﻮ اﻟﺨﻴﺮ‬
‫رﺋﻴﺲ‪ ‬ﻣﺸﺎرك اﻟﻠﺠﻨﺔ اﻟﻌﻠﻤﻴﺔ ﻟﻤﺒﺎدرة ﺗﺤﺴﻴﻦ اﻟﻌﻨﺎﻳﺔ ﺑﻤﺮﺿﻰ اﻟﺴﺮﻃﺎن ﺑﺎﻟﻌﺎﻟﻢ اﻟﻌﺮﺑﻲ‬
‫___________________________‬
‫اﻟﺪآﺘﻮر ‪ /‬ﺳﺎﻣﻲ اﻟﺨﻄﻴﺐ‬
‫اﻷﻣﻴﻦ اﻟﻌﺎم ﻟﺮاﺑﻄﺔ أﻃﺒﺎء اﻟﻌﺮب ﻟﻤﻜﺎﻓﺤﺔ اﻟﺴﺮﻃﺎن ‪ ‬‬
‫____________________________‬
‫ﻣﻌﺎﻟﻲ اﻟﺪآﺘﻮر ‪ /‬ﺑﻨﺪر ﺑﻦ ﻋﺒﺪ اﻟﻤﺤﺴﻦ اﻟﻘﻨﺎوي‬
‫اﻟﻤﺪﻳﺮ اﻟﻌﺎم اﻟﺘﻨﻔﻴﺬي ﻟﻠﺸﺆون اﻟﺼﺤﻴﺔ ﺑﺎﻟﺤﺮس اﻟﻮﻃﻨﻲ‬
‫اﻟﺮﻳﺎض – اﻟﻤﻤﻠﻜﺔ اﻟﻌﺮﺑﻴﺔ اﻟﺴﻌﻮدﻳﺔ‬

‫اﻟﻤﺸﺮﻓﻮن ﻋﻠﻰ ﻣﺠﻤﻮﻋﺎت اﻟﻌﻤﻞ ‪:‬‬
‫‪ -‬اﻟﺒﺮاﻣﺞ اﻟﻮﻃﻨﻴﺔ اﻻﺳﺘﺮاﺗﻴﺠﻴﺔ ﻟﻤﻜﺎﻓﺤﺔ اﻟﺴﺮﻃﺎن‬

‫اﻟﺪآﺘﻮر ‪ /‬ﻋﺒﺪ اﷲ اﻟﻌﻤﺮو – اﻟﺠﻤﻌﻴﺔ اﻟﺴﻌﻮدﻳﺔ ﻟﻤﻜﺎﻓﺤﺔ اﻟﺴﺮﻃﺎن – ﻣﺪﻳﻨﺔ اﻟﻤﻠﻚ ﻓﻬﺪ اﻟﻄﺒﻴﺔ‬
‫اﻟﻤﻤﻠﻜﺔ اﻟﻌﺮﺑﻴﺔ اﻟﺴﻌﻮدﻳﺔ‬
‫‪ -‬ﺗﻤﻮﻳﻞ رﻋﺎﻳﺔ ﻣﺮﺿﻰ اﻟﺴﺮﻃﺎن‬

‫اﻟﺪآﺘﻮر‪ /‬ﺷﺮﻳﻒ أﺑﻮ اﻟﻨﺠﺎ – ﻣﺴﺘﺸﻔﻰ ﺳﺮﻃﺎن اﻷﻃﻔﺎل ‪ - 57357‬ﻣﺼﺮ‬
‫اﻟﺪآﺘﻮر ‪ /‬ﻓﻼح اﻟﺨﻄﻴﺐ – ﻣﺮآﺰ اﻟﺨﻠﻴﺞ اﻟﺪوﻟﻲ ﻟﻠﺴﺮﻃﺎن ‪ -‬اﻻﻣﺎرات اﻟﻌﺮﺑﻴﺔ اﻟﻤﺘﺤﺪة‬
‫‪ -‬اﻟﻜﺸﻒ اﻟﻤﺒﻜﺮ ﻋﻦ اﻟﺴﺮﻃﺎن‬

‫اﻟﺪآﺘﻮرة ‪ /‬أم اﻟﺨﻴﺮ أﺑﻮ اﻟﺨﻴﺮ – اﻟﺸﺆون اﻟﺼﺤﻴﺔ ﻟﻠﺤﺮس اﻟﻮﻃﻨﻲ – اﻟﻤﻤﻠﻜﺔ اﻟﻌﺮﺑﻴﺔ اﻟﺴﻌﻮدﻳﺔ‬
‫اﻟﺪآﺘﻮر ‪ /‬ﻓﻴﺼﻞ اﻟﺼﺎﻓﻲ – اﻟﺸﺆون اﻟﺼﺤﻴﺔ ﻟﻠﺤﺮس اﻟﻮﻃﻨﻲ – اﻟﻤﻤﻠﻜﺔ اﻟﻌﺮﺑﻴﺔ اﻟﺴﻌﻮدﻳﺔ‬
‫اﻟﺪآﺘﻮرة ‪ /‬درﻳﺔ ﺳﺎﻟﻢ – ﺟﺎﻣﻌﺔ اﻟﻘﺎهﺮة ‪ -‬ﻣﺼﺮ‬
‫‪ -‬ﻣﻜﺎﻓﺤﺔ اﻟﺘﺪﺧﻴﻦ‬
‫اﻟﺪآﺘﻮر ‪ /‬ﻧﺎﺟﻲ ﺻﻐﻴﺮ – اﻟﺠﺎﻣﻌﺔ اﻷﻣﺮﻳﻜﻴﺔ ﺑﺒﻴﺮوت ‪ -‬ﻟﺒﻨﺎن‬
‫اﻟﺪآﺘﻮر ‪ /‬اﻟﺴﻴﺪ ﺳﺎﻟﻢ – ﺟﺎﻣﻌﺔ روﺳﺘﺎك ﻟﻠﻌﻠﻮم اﻟﺘﻄﺒﻴﻘﻴﺔ – ﻋُﻤﺎن‬
‫‪ -‬ﺗﻨﻤﻴﺔ اﻟﻤﻮارد اﻟﺒﺸﺮﻳﺔ‬

‫اﻟﺪآﺘﻮر ‪ /‬ﻋﺒﺪ اﻟﺮﺣﻤﻦ ﺟﺎزﻳﺔ – اﻟﺸﺆون اﻟﺼﺤﻴﺔ ﻟﻠﺤﺮس اﻟﻮﻃﻨﻲ – اﻟﻤﻤﻠﻜﺔ اﻟﻌﺮﺑﻴﺔ اﻟﺴﻌﻮدﻳﺔ‬
‫‪ -‬اﻟﺴﺠﻼت واﻟﺒﻴﺎﻧﺎت‬
‫اﻟﺪآﺘﻮر ‪ /‬ﻋﻠﻲ اﻟﺰهﺮاﻧﻲ – ﻣﺮآﺰ اﻟﺨﻠﻴﺞ ﻟﺴﺠﻼت ﻣﺮض اﻟﺴﺮﻃﺎن ‪ -‬اﻟﻤﻤﻠﻜﺔ اﻟﻌﺮﺑﻴﺔ اﻟﺴﻌﻮدﻳﺔ‬
‫اﻟﺪآﺘﻮر ‪ /‬ﺷﻮﻗﻲ ﺑﺎزارﺑﺎﺷﻲ – ﻣﺴﺘﺸﻔﻰ اﻟﻤﻠﻚ ﻓﻴﺼﻞ اﻟﺘﺨﺼﺼﻲ وﻣﺮآﺰ اﻷﺑﺤﺎث ‪ -‬اﻟﻤﻤﻠﻜﺔ اﻟﻌﺮﺑﻴﺔ اﻟﺴﻌﻮدﻳﺔ‬
‫‪ -‬ﺗﺸﺨﻴﺺ ﻣﺮض اﻟﺴﺮﻃﺎن‬

‫اﻟﺪآﺘﻮرة ‪ /‬أﺳﻤﺎء اﻟﺪﺑﺎغ – ﺟﺎﻣﻌﺔ اﻟﻤﻠﻚ ﻋﺒﺪ اﻟﻌﺰﻳﺰ ) ﺟﺪة ( ‪ -‬اﻟﻤﻤﻠﻜﺔ اﻟﻌﺮﺑﻴﺔ اﻟﺴﻌﻮدﻳﺔ‬
‫اﻟﺪآﺘﻮر ‪ /‬ﻋﺒﺪ اﻟﻤﺤﺴﻦ اﻟﻜﻮﺷﻲ – اﻟﺸﺆون اﻟﺼﺤﻴﺔ ﻟﻠﺤﺮس اﻟﻮﻃﻨﻲ – اﻟﻤﻤﻠﻜﺔ اﻟﻌﺮﺑﻴﺔ اﻟﺴﻌﻮدﻳﺔ‬
‫‪ -‬ﻣﻌﺎﻳﻴﺮ اﻟﺮﻋﺎﻳﺔ واﻻرﺷﺎدات ﻟﻠﺪول اﻟﻌﺮﺑﻴﺔ‬

‫اﻟﺪآﺘﻮر ‪ /‬ﻧﺎﺟﻲ ﺻﻐﻴﺮ – اﻟﺠﺎﻣﻌﺔ اﻷﻣﺮﻳﻜﻴﺔ ﺑﺒﻴﺮوت ‪ -‬ﻟﺒﻨﺎن‬
‫اﻟﺪآﺘﻮر ‪ /‬ﺣﻤﺪي ﻋﺒﺪ اﻟﻌﻈﻴﻢ – ﺟﺎﻣﻌﺔ اﻟﻘﺎهﺮة ‪ -‬ﻣﺼﺮ‬
‫‪ -‬أوﻟﻮﻳﺎت ﺗﻄﻮﻳﺮ اﻷﺑﺤﺎث ﻓﻲ اﻟﺪول اﻟﻌﺮﺑﻴﺔ‬

‫اﻟﺪآﺘﻮر ‪ /‬ﻋﻠﻰ ﺷَﻨﻘﻴﻄﻲ – ﻣﺪﻳﻨﺔ اﻟﻤﻠﻚ ﻋﺒﺪ اﻟﻌﺰﻳﺰ ﻟﻠﻌﻠﻮم واﻟﺘﻜﻨﻮﻟﻮﺟﻴﺎ ‪ -‬اﻟﻤﻤﻠﻜﺔ اﻟﻌﺮﺑﻴﺔ اﻟﺴﻌﻮدﻳﺔ‬
‫اﻟﺪآﺘﻮرة ‪ /‬ﺳﻨﺎء اﻟﺴﺨﻦ – اﻟﺠﺎﻣﻌﺔ اﻷردﻧﻴﺔ ‪ -‬اﻷردن‬
‫‪ -‬ﻣﺮاﻓﻖ اﻟﻌﻨﺎﻳﺔ ﺑﻤﺮﺿﻰ اﻟﺴﺮﻃﺎن‬

‫اﻟﺪآﺘﻮر ‪ /‬ﻓﺎدي ﺟﻌﺎرة – اﻟﺠﺎﻣﻌﺔ اﻷﻣﺮﻳﻜﻴﺔ ﺑﺒﻴﺮوت ‪ -‬ﻟﺒﻨﺎن‬
‫اﻟﺴﻴﺪة ‪ /‬رﺑﺎب دﻳﺎب – ﻣﺆﺳﺴﺔ اﻟﻤﻠﻚ ﺣﺴﻴﻦ ﻟﻠﺴﺮﻃﺎن واﻟﺘﻜﻨﻮﻟﻮﺟﻴﺎ اﻟﺤﻴﻮﻳﺔ ‪ -‬اﻷردن‬
‫‪ -‬اﻟﺤﺼﻮل ﻋﻠﻰ أدوﻳﺔ ﻋﻼج اﻟﺴﺮﻃﺎن‬

‫اﻟﺪآﺘﻮر ‪ /‬أﺣﻤﺪ ﺳﻌﺪ اﻟﺪﻳﻦ – ﻣﺴﺘﺸﻔﻰ اﻟﺮﻳﺎض اﻟﻌﺴﻜﺮي ‪ -‬اﻟﻤﻤﻠﻜﺔ اﻟﻌﺮﺑﻴﺔ اﻟﺴﻌﻮدﻳﺔ‬
‫اﻟﺪآﺘﻮرة ‪ /‬ﻧﻮر ﻋﺒﻴﺪات – ﻣﺆﺳﺴﺔ اﻟﻤﻠﻚ ﺣﺴﻴﻦ ﻟﻠﺴﺮﻃﺎن واﻟﺘﻜﻨﻮﻟﻮﺟﻴﺎ اﻟﺤﻴﻮﻳﺔ ‪ -‬اﻷردن‬
‫‪ ‬‬

‫‪ -‬اﻟﺮﻋﺎﻳﺔ اﻟﺘﻠﻄﻴﻔﻴﺔ‬
‫اﻟﺪآﺘﻮر ‪ /‬ﻋﻤﺮ ﺷﺎﻣﻴﺔ – اﻟﺸﺆون اﻟﺼﺤﻴﺔ ﻟﻠﺤﺮس اﻟﻮﻃﻨﻲ – اﻟﻤﻤﻠﻜﺔ اﻟﻌﺮﺑﻴﺔ اﻟﺴﻌﻮدﻳﺔ‬
‫اﻟﺪآﺘﻮر ‪ /‬راﻓﻊ اﻟﺸﻬﺮي – اﻟﺸﺆون اﻟﺼﺤﻴﺔ ﻟﻠﺤﺮس اﻟﻮﻃﻨﻲ – اﻟﻤﻤﻠﻜﺔ اﻟﻌﺮﺑﻴﺔ اﻟﺴﻌﻮدﻳﺔ‬
‫اﻟﺪآﺘﻮر ‪ /‬ﻣﺤﻤﺪ اﻟﻔﻮدة – ﻣﺴﺘﺸﻔﻰ اﻟﻤﻠﻚ ﻓﻴﺼﻞ اﻟﺘﺨﺼﺼﻲ وﻣﺮآﺰ اﻷﺑﺤﺎث ‪ -‬اﻟﻤﻤﻠﻜﺔ اﻟﻌﺮﺑﻴﺔ اﻟﺴﻌﻮدﻳﺔ‬
‫‪ -‬اﻟﺘﻐﻠﺐ ﻋﻠﻰ ﺗﺤﺪﻳﺎت رﻋﺎﻳﺔ اﻷﻃﻔﺎل اﻟﻤﺮﺿﻰ ﺑﺎﻟﺴﺮﻃﺎن ﻓﻲ اﻟﻌﺎﻟﻢ اﻟﻌﺮﺑﻲ‬

‫اﻟﺪآﺘﻮرة ‪ /‬رﻳﻢ اﻟﺴﺪﻳﺮي – اﻟﺸﺆون اﻟﺼﺤﻴﺔ ﻟﻠﺤﺮس اﻟﻮﻃﻨﻲ – اﻟﻤﻤﻠﻜﺔ اﻟﻌﺮﺑﻴﺔ اﻟﺴﻌﻮدﻳﺔ‬
‫اﻟﺪآﺘﻮر ‪ /‬ﻣﺤﻤﺪ ﺟﺮار – اﻟﺸﺆون اﻟﺼﺤﻴﺔ ﻟﻠﺤﺮس اﻟﻮﻃﻨﻲ – اﻟﻤﻤﻠﻜﺔ اﻟﻌﺮﺑﻴﺔ اﻟﺴﻌﻮدﻳﺔ‬

‫اﻟﺨﺒﺮاء واﻟﻤﺴﺘﺸﺎرون اﻟﺪوﻟﻴﻴﻦ ‪:‬‬

‫اﻟﺪآﺘﻮر ‪ /‬ﺗﻮﻧﻲ ﻣﻴﻠﺮ‬
‫ﺟﺎﻣﻌﺔ داﻻ ﻻﻧﺎ ﻟﻠﺼﺤﺔ اﻟﻌﺎﻣﺔ‬
‫آﻨﺪا‬
‫اﻟﺪآﺘﻮرة ‪ /‬ﺳﻴﺴﻴﻠﻴﺎ ﺳﺒﻴﻮﻟﻔﻴﺪا‬

‫ﻣﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ‬
‫ﺳﻮﻳﺴﺮا‬
‫اﻟﺪآﺘﻮر ‪ /‬ﻓﺮاﻧﻜﻮ آﺎﻓﺎﻟﻲ‬

‫ﻣﻌﻬﺪ اﻷورام ﺑﺠﻨﻮب ﺳﻮﻳﺴﺮا‬
‫ﺳﻮﻳﺴﺮا ‪ ‬‬
‫‪ ‬‬
‫اﻟﺪآﺘﻮرة ‪ /‬اﺑﺘﻬﺎل ﻓﻀﻞ‬
‫ﻣﺼﺮ‬
‫اﻟﺒﺮوﻓﺴﻮر ‪ /‬ﺟﻮن – ﺟﺎك زﻳﻤﺒﺮوﺳﻜﻲ‬

‫ﻣﺴﺘﺸﻔﻰ ﺟﺎﻣﻌﺔ ﺑﻴﻜﺎ‬
‫ﻓﺮﻧﺴﺎ‬
‫اﻟﺪآﺘﻮر ‪ /‬ﺑﻴﻦ أﻧﺪرﺳﻮن‬

‫ﻣﺮآﺰ ﻳﻮ دﺑﻠﻴﻮ أم ﺳﻲ روزﻓﻴﻠﺖ‬
‫اﻟﻮﻻﻳﺎت اﻟﻤﺘﺤﺪة اﻷﻣﺮﻳﻜﻴﺔ‬
‫اﻟﺪآﺘﻮر ‪ /‬أﻟﻴﻜﺲ أدﺟﻲ‬

‫ﻣﻌﻬﺪ اﻟﺴﺮﻃﺎن ﺑﺮوﺳﻮﻳﻞ ﺑﺎرك‬
‫اﻟﺪآﺘﻮرة ‪ /‬ﻓﺪوى ﻋﺘﻴﻘﺔ‬

‫ﺧﺒﻴﺮة أﺑﺤﺎث أﺳﺎﺳﻴﺔ‬
‫اﻷردن‬
‫اﻟﺪآﺘﻮر ‪ /‬راؤول رﻳﺒﻴﺮو‬

‫ﻣﺴﺘﺸﻔﻰ ﺳﺎن ﺟﻮد ﻷﺑﺤﺎث اﻷﻃﻔﺎل‬
‫اﻟﺪآﺘﻮر ‪ /‬دﻳﻔﻴﺪ آﻴﺮ‬

‫ﻣﺮآﺰ ﺳﻴﺪرا ﻟﻸﺑﺤﺎث اﻟﻄﺒﻴﺔ‬
‫ﻗﻄﺮ‬
‫اﻟﺪآﺘﻮر ‪ /‬ﻣﻮهﻴﺮا ﻟﻴﻨﺞ‬

‫آﺎردﻳﺎس ‪ -‬اﻟﻤﻌﻮﻧﺔ اﻟﺪوﻟﻴﺔ ﻟﻠﺮﻋﺎﻳﺔ اﻟﺘﻠﻄﻴﻔﻴﺔ‬
‫آﺎﻣﺒﺎﻻ‬
‫اﻟﺪآﺘﻮر ‪ /‬ﻏﺴﺎن أﺑﻮﻋﻠﻔﺎ‬

‫ﻣﺮآﺰ ﻣﻴﻤﻮرﻳﺎل ﺳﻠﻮن آﻴﺘﻴﺮﻧﺞ ﻟﻠﺴﺮﻃﺎن‬

‫اﻟﺪآﺘﻮرة ‪ /‬ﺑﺎري ﺑﻠﻮﻓﻴﻠﺖ‬

‫ﻣﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ – ﺟﺎﻣﻌﺔ ﻣﺎﺳﺎﺷﻮﺳﺘﺲ‬
‫اﻟﺪآﺘﻮرة ‪ /‬ﻟﻴﺰﻟﻲ ﻟﻴﻤﺎن‬

‫ﻣﺴﺘﺸﻔﻰ ﺑﻮﺳﻄﻦ ﻟﻸﻃﻔﺎل‬
‫ﺟﺎﻣﻌﺔ هﺎرﻓﺎرد ﻟﻠﻄﺐ‬
‫اﻟﺴﻴﺪة ‪ /‬آﺎﺛﻠﻴﻦ هﻮﻻهﺎن‬

‫ﻣﺴﺘﺸﻔﻰ ﺑﻮﺳﻄﻦ ﻟﻸﻃﻔﺎل‬
‫ﺟﺎﻣﻌﺔ هﺎرﻓﺎرد ﻟﻠﻄﺐ‬
‫اﻟﻬﻴﺌﺎت اﻟﻤﻨﻈﻤﺔ ‪:‬‬

‫اﻟﺤﺮس اﻟﻮﻃﻨﻲ ﻟﻠﺸﺆون اﻟﺼﺤﻴﺔ ‪ ،‬اﻟﻤﻤﻠﻜﺔ اﻟﻌﺮﺑﻴﺔ اﻟﺴﻌﻮدﻳﺔ‬
‫راﺑﻄﺔ أﻃﺒﺎء اﻟﻌﺮب ﻟﻤﻜﺎﻓﺤﺔ اﻟﺴﺮﻃﺎن‬
‫ﻣﻨﻈﻤﺎت ﻣﺸﺎرآﺔ ‪:‬‬

‫اﻻﺗﺤﺎد اﻟﺪوﻟﻲ ﻟﻤﻜﺎﻓﺤﺔ اﻟﺴﺮﻃﺎن‬
‫وزراة اﻟﺼﺤﺔ اﻟﺴﻌﻮدﻳﺔ‬
‫اﻟﺠﻤﻌﻴﺔ اﻟﺴﻌﻮدﻳﺔ اﻟﺨﻴﺮﻳﺔ ﻟﻤﻜﺎﻓﺤﺔ اﻟﺴﺮﻃﺎن‬
‫اﻟﻜﻠﻴﺔ اﻟﻌﺮﺑﻴﺔ اﻵورﺑﻴﺔ ﻟﻸورام‬
‫اﻟﺠﻤﻌﻴﺔ اﻷوروﺑﻴﺔ ﻟﻸورام‬
‫ﺟﻤﻌﻴﺔ ﺳﻨﺪ اﻟﺨﻴﺮﻳﺔ ﻟﺪﻋﻢ اﻷﻃﻔﺎل اﻟﻤﺮﺿﻰ ﺑﺎﻟﺴﺮﻃﺎن‬
‫ﺟﻤﻌﻴﺔ زهﺮة ﻟﺴﺮﻃﺎن اﻟﺜﺪي‬
‫اﻟﻤﺆﺳﺴﺔ اﻟﺴﻌﻮدﻳﺔ ﻟﻸورام‬
‫اﻟﻬﻴﺌﺔ اﻟﺼﺤﻴﺔ ﻟﻤﺠﻠﺲ اﻟﺘﻌﺎون اﻟﻌﺮﺑﻲ‬
‫ﺟﻤﻌﻴﺔ اﻟﺒﺤﺮﻳﻦ ﻟﻤﻜﺎﻓﺤﺔ اﻟﺴﺮﻃﺎن ‪ ‬‬
‫اﻟﺘﺼﻨﻴﻒ ‪:‬‬
‫وﺿﻌﻴﺔ اﻷﻓﻜﺎر ﻓﻲ ﺷﻜﻞ ‪ : 1‬ﻳﻬﺪف ﺗﺼﻨﻴﻒ اﻟﺮﻋﺎﻳﺔ اﻟﺸﺎﻣﻠﺔ ﻟﻤﺮﺿﻰ اﻟﺴﺮﻃﺎن وﻣﻜﺎﻓﺤﺘﻪ ﺑﺎﻟﻌﺎﻟﻢ اﻟﻌﺮﺑﻲ إﻟﻰ‬
‫ﻣﺴﺎﻋﺪة اﻟﻘﺎرئ ﻋﻠﻰ ﺗﺼﻮر اﻟﻌﻼﻗﺔ اﻟﻤﺘﺒﺎدﻟﺔ ﺑﻴﻦ اﻟﻤﻮاﺿﻴﻊ اﻟﺘﻲ ﻳﺘﻨﺎوﻟﻬﺎ اﻟﺒﻴﺎن وﻟﻴﺲ اﻟﻤﻘﺼﻮد ﺑﻬﺎ أن ﻳﺤﺪد أهﻤﻴﺔ‬
‫ﻣﻮﺿﻮع ﻋﻠﻰ اﻻﺧﺮ ‪.‬‬
‫اﻟﻤﺮاﺟﻊ ‪:‬‬
‫‪ -1‬اﻻﺗﺤﺎد اﻟﺪوﻟﻲ ﻟﻤﻜﺎﻓﺤﺔ اﻟﺴﺮﻃﺎن )‪ . ( 2006‬إﻋﻼن اﻟﺴﺮﻃﺎن اﻟﻌﺎﻟﻤﻲ ‪ 25‬ﻣﺎرس ‪2010‬‬

‫‪.http://www.uicc.org‬‬
‫‪ -2‬ﻣﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ )‪ – (2008‬اﺳﺘﺮاﺗﻴﺠﻴﺔ ﻟﻤﻜﺎﻓﺤﺔ اﻟﺴﺮﻃﺎن ﻓﻲ إﻗﻠﻴﻢ ﺷﺮق اﻟﻤﺘﻮﺳﻂ ) ‪(2013 – 2009‬‬
‫‪ -‬ﻣﺴﻮدة ﻧﻬﺎﺋﻴﺔ ﻣﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ – اﻟﻤﻜﺘﺐ اﻹﻗﻠﻴﻤﻲ ﻟﺸﺮق اﻟﻤﺘﻮﺳﻂ ‪WHO‐EM/NCD/060/E‬‬
‫‪http://www.emro.who.int/publications/Book_Details.asp?ID=1002.‬‬
‫‪ ‬‬

Individual Panel 12 Month Project
March 23 – 25, 2010 – Riyadh, KSA

The following are the individual panel 12 month projects that were agreed upon
at the Inaugural Meeting of the Initiative to Improve Cancer Care in the Arab
World.

1. National Cancer Policy & Control Programs Panel:
• Develop a process to help establishing national cancer control
committee with high level representation and term of reference.
• Establish an annual national cancer care meeting.

2. Funding Cancer Care Panel:
• Developing a fundraising training program for participating non‐
government organizations (NGOs) and hospitals.
• Defining and allocating the portfolio and resources of each
organization involved and prioritizing funding needs.
• Develop a pilot twinning training process with at least one
representative from an interested organization with the Children’s
Cancer Hospital Egypt 57357 Foundation fund raising team.
• Establishing a regional chapter of the AFP (Association of Fundraising
Professionals) to share fundraising science and experience globally.
• Identifying some of the different regional strategies for funding
cancer care such as the community health insurance program.

Action Steps:
a. Confirm with all panel members level of interest and participation for
the 12 month project.
b. Developing a fund raising training program for participating non‐
governmental organizations (NGOs) and hospitals.
• Develop concept paper for regional fundraising training.
c. Defining and allocating the portfolio and resources of each
organization involved and prioritizing funding needs.
• What is their most urgent fundraising need for this year for
their institution and patients and expected cost.
d. Develop a pilot twinning training process with at least one
Cancer Hospital Egypt 57357 Foundation fundraising team.
e. Establishing a regional chapter of the AFP (Association of Fundraising
Professionals) to build capacity, share fundraising science and
experience globally. [Process has started with Dr. Sherif Abouelnaga
and fundraising team] time line for achievement: within 3‐6 months.
f. Identifying some of the different regional strategies for funding
cancer such as the community health insurance program.
• Request will go out to put in writing the different methods of
raining funds in each country.
• What has been successful and what has not.
• What is governmental response to individual efforts for
fundraising for cancer projects such as medication support,
facility and equipment upgrade, etc.

3. Cancer Screening and Prevention Programs Panel:
• Develop a training program curriculum for primary care physicians
and other health care professionals about cancer prevention,
screening and early detection.
• Develop a manual (guide) for the process of establishing cancer
screening center including steps, requirements and challenges.

4. Tumor Registries Panel:
• Establish regional training and development programs for tumor
registrars to improve productivity of current registrars and overcome
shortage of trained staff.

5. Human Resources Development Panel:
• Develop postgraduate program proposals for physicians, nurses and
other disciplines.
• Develop Oncology Human Resources Information Manual

Action Steps:
a. Develop a regional committee of interested individuals to
address the above two project.

6. Tobacco Control Panel:
• Conduct an assessment of the magnitude of tobacco consumption in
the Arab World and publicize it.
• Develop proposal for a road map to approach tobacco control at
different levels.

Action Steps:
a. Develop tobacco control steering committee.
b. Review existing anti tobacco initiatives
c. Establish a communication with anti‐tobacco organizations and
societies.
d. Write a strategic plan for tobacco control.

7. Access to Cancer Care Facilities Panel
• Conduct situation analysis for cancer care facilities.
• Develop quality standards for cancer care facilities.

8. Standard of Care & Guidelines in the Arab Countries Panel:
• Develop training program for oncology care professionals about
guideline development and implementation.
• Identify an internationally accepted guidelines to be adapted for the
region.

9. Access to Cancer Care Medications Panel
Conduct a situation analysis, generate document and roadmaps to
help plan projects to improve access to cancer medications in Arab
World.
Action Steps:
a. Formulate group – who will do this and how (include an
organization to endorse, eg. WHO, UICC).
b. Develop or modify survey tool to systematically capture data
across countries:
Agree on key elements to capture (focused survey)
Agree on target respondents
Develop protocol for survey procedure
c. Seek funding.
d. Pilot and subsequently refine protocol as necessary.
e. Implementation.
f. Reporting.
Revisit panel short‐, intermediate‐ and long‐term
objectives
Provide recommendations

10. Research Development Priorities in the Arab Countries Panel:
• Develop high quality regional workshop on clinical cancer research
• Conduct a survey of existing research infrastructure
• Initiate the process of establishing an Arab Cooperative Oncology
Group (ACOG).

11. Diagnosis of Cancer
• Generating a proposal to develop virtual National Reference center
for cancer diagnosis
• Establishment of quality control assessment strategy for equipment
used in cancer diagnosis
• Standardization of imaging protocols through guidelines.

Action Steps
• Working in a team to generate a proposal to develop virtual National
Reference center for cancer diagnosis to be presented to high
management of health care facilities in the Arab countries.
• Implementing this reference center at least in one country to be used
as pilot.
• Issuing check lists for equipment quality control requirements to
hospitals and medical centers, by qualified physicists.
• Encourage using the approved diagnostic protocols and reporting
guidelines by International authorities.
12. Access to Palliative Care Panel
• Identify gaps in palliative care services and resource provision for the
cancer patient population in Arab world.

Action Steps:
a. Initiate Arab World mapping of available palliative care
services; facilities; manpower; medical, nursing and other
cancer professional educational institutions; financial
resources; community/volunteer programs for cancer patients
b. Identify available opioids and essential medications, opioid
policies, dispensing, and prescription practices, opioid
consumption and administrative management of opioids from
each country.

13. Overcoming Challenges of Pediatric Cancer Care in the Arab World
• Establishing a Regional Network of Pediatric Oncologists

Action Steps:
1. Interested representatives participating in ICCAW will be invited
to the network.
2. Representatives from other countries can join the network later
on.
3. The network members will have regular teleconferences to
discuss various issues and act on 3 major topics:
• Patients care
• Training & education
• Research opportunities
Individual Panel Reports

Individual Panel Reports

1. Establishing Cancer Screening Early Detection and Prevention Program
2. Human Resources Development
3. Tobacco Control
4. Access to Cancer Care Facilities
5. Diagnosis of Cancer
6. Overcoming Challenges of Pediatric Cancer Care in the Arab World
7. Funding Cancer Care
8. Standards of Care and Guidelines in the Arab Countries with Limited
Resources
9. Tumor Registry
10. Access to Cancer Care Medications
11. Access to Palliative Care
12. National Cancer Policy and Control Programs

Cancer Prevention, Screening and Early Detection Inaugural Meeting Report

Establishing Cancer Screening

Early Detection & Prevention

Program

Cancer Prevention, Screening and
Early Detection
Dr. Omalkhair Abulkhair, Dr. Faisal Al Safi and Dr. Dorria Salem
*on behalf of the Cancer Prevention, Screening and Early Detection Panel Members

PANEL OBJECTIVES
Describe the current screening and prevention programs in the region.
Discuss the challenges of the establishing screening and prevention
programs.
Present recommendations and future steps to develop cancer screening
programs in the Arab region.

PANEL MEMBERS
Facilitators
Name Title Institution Country
King Abdulaziz Medical
Dr. Omalkhair Abulkhair Section Head & Consultant Saudi Arabia
City
Dr. Faisal Al Safi Section Head & Consultant Saudi Arabia
City
Dr. Dorria Salem Consultant, Radiology Cairo University Egypt
International Expert
Dr. Tony Miller University of Toronto Canada
Panel Members
Consultant, Breast Radiologist
Dr. Fatina Al Tahan Director, Training Medical Saudi Arabia
City
Imaging
King Fahad Specialist
Dr. Nadia Al Eissa Staff Radiologist Saudi Arabia
Hospital, Dammam
Consultant, Radiologist,
Dammam University
Prof. Fatma Al Mulhim Professor, Chairperson, Saudi Arabia
King Fahad Hospital
Radiology Department
Senior Consultant
Dr. Salha Bujassoum Al – Amal Cancer Center Qatar
Hematologist‐ Oncologist
Assistant Professor &
Dr. Abdulaziz Al Saif Consultant King Saud University Saudi Arabia
Breast and Endocrine Surgeon
Associate Consultant King Abdulaziz Medical
Dr. Nashmia Al Mutairi Saudi Arabia
Gynecology Oncology City
Prof. Rasha Kamal Professor of Radiology Cairo University Egypt
Coordinator, Breast Cancer Federal Ministry of Health
Dr. Aida Omer Mustafa Sudan
Control Program Khartoum Teaching Hosp

Dr. Jamal Jaafar Al Sayyad Ministry of Health Bahrain
Director GyneOnc King Faisal Specialist
Dr. Hany Salem Saudi Arabia
Fellowship Program Hosp. & Research Center
Consultant & Radiologist Head King Abdulaziz Hospital –
Dr. Iman Baroum Saudi Arabia
of Breast Imaging Unit Oncology Center
King Fahad Specialist
Dr. Maha Al Adrisi Consultant, Radiation Oncology Saudi Arabia
Hospital
Name Email Contact Info

Jazzylyn Rodriguez rodriguezja@ngha.med.sa +96612520088 Ext 14107 / Fax:
+96612520088 Ext 14691
Panel Guest
Name Organization
Prof. Asma Al Dabbagh 1.KAUH , Jeddah, Saudi Arabia
Dr. Iman Baroum King Abdulaziz Hospital
Pharm. Wafa Al
Shammary NCD – MOH, Saudi Arabia
Dr. Haifa Nassri NCD – MOH, Saudi Arabia
Dr. Mohamed Y. Sazzdi NCD – MOH, Saudi Arabia
Dr. Emad Raddaoni KKUH
Dr. Abdulmoshen Kushi KAMC ‐ NGHA
Dr. Hussein MohD Wahba Imam University Medical Center
Dr. Aysha Al Zamar Bahrain Cancer Society
Dr. Nagi El Saghir AUB
Ms. Daniela Mengato EASO
Ms. Roberta Ventura EASO
Dr. Nouf Al – Dhwayan KFSH / Zahra BC Association
Dr. Nada Al – Faraj NGHA, Dammam, Saudi Arabia
Ms. Naeemah Al Qanbar NGHA, Dammam, Saudi Arabia
Dr. Ahmed A. Shamlan NOC, NCCF
Dr. Hani Fannoush NGHA, Riyadh, Saudi Arabia
Dr. Rabab Diab KHIBC
Ms. Angela Minaar Royal Clinic
Engr. Saad Al Sadhan GE Healthcare
Dr. Mohamed Reda Gado S.F
Dr. Mohamed Ameen
Khahab S.F
Dr. Essam Eldin Ibrahim MOH

ABSTRACT

Introduction:
There is a growing burden of cancer worldwide. The largest increase in the Eastern
Mediterranean Region, in which projection modeling predicts an increase between
100% and 180%. The most frequent cancer sites are variable in different regions but
breast is the most common in females. At present, resources for cancer control in
the region are directed to treatment, although 40% can be cured if detected early.
The top five cancers in the region for both male and female: breast, bladder, lung,
oral and colon cancer

Method:
An assessment tool, included situational analysis, objective and recommendation,
completed by panel members; complied and consensus reached.

Results:
13 out of 15 panel members responded and completed the Initial Assessment and
Recommendation Tool. Lists of strengths and challenges were agreed on.

Conclusion:
Consensus among the panel reached towards number of recommendation and
objectives. And finally 3 objectives for the next 12 months will be approved by the
panel and action step as well as the indicator.


INTRODUCTION

According to World health Organization mortality estimates, cancer is the fourth
ranked cause of death in the Eastern Mediterranean Region. It is estimated that
cancer kills 272, 000 people each year in the region. {1}

There is a growing burden cancer worldwide. The largest increase in cancer
incidence among the World Health Organization regions in the next 15 years is likely
to be in the Eastern Mediterranean Region, in which projection modeling predicts an
increase between 100% and 180%. At present, resources for cancer control in the
region as a whole are not only inadequate but directed almost exclusively to
treatment. {2}

It is known that 30 ‐ 40% of cancers can be prevented and 30 ‐ 40% can be cured if
detected early.

Incidence and Mortality:

The age standardized incidence (ASR) of all cancers in the Region is currently 3 to 4
times lower than in the industrialized countries. {3}

The mortality / incidence ratio is 70% which is high (40% in America, 55 % in Europe),
indicating significantly lower survival rates from diagnosed cancer. The following top
five cancers in the region when males and females are combined:
breast
bladder
lung
oral cavity
colon cancer

These cancers can either be prevented (bladder and lung), or detected early (breast,
oral and Colon).

Most cancers are diagnosed at an advanced stage, emphasizing on the potential role
for early detection. Diagnosis and treatment depends heavily on resources.

Prevent preventable cancers (through avoiding and reducing exposure to risk factors,
i.e prevention strategies)

Cure curable cancers (early detection, diagnostic and treatment strategies).

METHODS AND MATERIALS

Methods:
The panel members completed an assessment tool including situational analysis,
objectives, recommendations with action steps and indicators and available
resources to support the objectives of the panels. The input was compiled and
consensus was reached about the final recommendations which are included in this
report.

Panel Formation
As part of the Initiative to Improve Cancer Care in the Arab World, Establishing
Cancer Screening and Early Detection and Prevention Program panel was formed
from individual involved in the cancer care in the region in different areas and
background.

SITUATIONAL ANALYSIS FINDINGS

a. Strengths / Success
Active participation of non‐ profit charitable organization in promoting
increase level of awareness in cancer prevention and early detection.
Support of tertiary care government hospitals for non‐ profit charitable
organization. With these limited efforts, they were able to establish
cancer screening program in different region ( Bahrain 2005, Egypt 2006,
Qatar , Qassem 2006, Riyadh 2007 and Dammam 2009)
Dedicated cancer healthcare professional – to increase promotion of
awareness and highlighting the importance of early detection of cancer.
Cancer therapy is free of charge in many Arab countries.

b. Challenges / Weaknesses.
Lack of organized governmental approach for national screening program
that will establish guidelines process and funding for screening programs.
Most healthcare facilities are condensed in major cities.
Lack of specialized healthcare physicians ( Medical Oncologist,
Gynecology – Oncologist, Radiologist, Technician, Staff Nurses, )
Lack of experienced leadership in screening planning and proper steps of
implementation.
Unclear referral system, and poor communication and coordination
between health care providers and sometimes duplication of services in
the same area.
There is no formal policy in the Ministry of Health and no local guidelines
to support the screening programs.
Lack of organized plan for research for epidemiological studies of risk
factors for cancer.
Public misconception of cancer.

RECOMMENDATIONS

a. Cancer Prevention

In cooperation with the government, a detailed strategic plan for cancer
prevention and early detection should be implemented.
Increase level of awareness among population through:

better utilization of media throughout the year
by focusing on general obesity, diet and physical activity –
adopt the global strategy on diet and physical activity, develop
and implement national dietary guidelines; increase public
awareness on the importance of physical activity especially in
workplaces and schools, modify school curricula to place
increasing emphasis on physical activity and provide time for
it.

*All countries in the region should introduce diet and physical activity programs
in line with WHO’s Global Strategy on Diet and Physical Activity.

b. Early Detection

Create awareness (public, professional and political)
Improve clinical diagnosis and treatment
Introduce appropriate referral pathways
Promote guidelines for diagnosis and treatment
Develop data collection systems
Introduce screening programs according to evidence.
Conduct high level specialized training programs for specialist such as
Mammography / Breast Imaging Breast Biopsy Workshop.


Table 1: Panel Recommendations

Objectives Action Steps Indicators Comments
Model could be Abdullatif
1. Pilot programs for evaluating the Develop a business plan. Number of cases cancer Screening center in
feasibility of screening should be Identifying and acquire done. Riyadh. Mobile units should
conducted only in countries where needed resources. Number of follow – provide services to people
adequate facilities for diagnosis and living in remote areas.
Develop clear guidelines. up to the center on
treatment can be guaranteed and Health professionals should
where the required resources will not Assess the function of the calling. be required to provide
be transferred from other health care center and the value of the Number of cases mammography and genetic
needs. screening. diagnosed at each counseling for those who
center. are at high risk. Pre‐marital
medical examination and
counseling, which has been
made mandatory recently in
the Kingdom, is a step in
the right direction and
Breast screening can be
treated similar for all ladies
after 40.

2. Train highly specialized and skilled To developed Sub – specialty
physician in all cancer related fellowship program in the
subspecialties (Medical Oncologist, fields of ( Radiology – Number of
Surgical Oncologist, Radiologist and submitted proposals
women imaging, tumor
Primary Care Physicians and Health Number of
Allied Staff). imaging, genetic counseling,.)
accredited

Medical Oncology Fellowship fellowship programs

Program for Saudi or Arab Number of trainees
Board enrolled in this
program
Training of personal to Submit the programs for Number of
Start screening programs of breast, accreditation from Arab
programs
cervical and oral cancer. Board and local Health
Specialty Boards established &

. Establish training programs number of trainees
in different major hospitals enrolled.
Establish affiliation with There are three
advanced centers in North proposals for
America and Europe. training of
Establishing training
screening of
programs in all these fields. In
affiliation with advanced breast ,cervical
centers in the world and oral cancer.
Develop fellowship programs
in the field of ways of
screening programs for
common cancers in the region
e.g. breast ,cervical and oral
cancer



3. Increase public awareness of the Use media (Radio, TV, It is very crucial to have
problem. Newspapers), Utilize SMS, Questionnaires to adequate setting/facilities
Raise Public awareness among the series of public forums gauge the effect of to accommodate people
potential patient population and the action steps. who wants to undergo
Dissemination of the
primary health care professionals screening and manage
knowledge that cancer in them.
Establish well organized public breast general, is not rapidly fatal if
cancer awareness program and diagnosed early and is, in
activities many cases, “curable”.
Work at three levels: inreach
and outreach programs as
well as public education
levels.
Supplying affordable and
easily accessible diagnostic
and therapeutic procedures.
Collaboration between all
those with an interest is
needed to encourage
population to have a correct
understanding of the disease
and to understand who is at
greatest risk, as well as
understanding the likely
symptoms and the need for
breast awareness
Organize awareness
campaigns at special
occasions.
Incorporation of advocacy
groups within any screening
project can certainly affect
the attitude, response and
acceptance of the public to
the delivered services.
Plan a wide media campaign
including television and radio
advertisements, as well as
poster campaigns on
transport vehicles and in
streets and shopping and
leisure centers.
Integrate supportive care
interventions within
screening programs, to
provide emotional and
spiritual, care to support

women.
Inclusion of breast cancer
education in the curriculum
of students in both high
school and in the medical
schools
Develop special program for
health education with
partnership of well known
institute in USA & Europe
More awareness campaign
and workshop.
Massive educational program
on breast cancer using multi‐
media tools and strategies
for the mass media.
4. Improve the present referral system. Ministry of Health to be in Sporadic case
Ensure timely access and effective charge of developing studies
referral of cancer cases to oncology competent referral system. number of referrals
centers Establish standard national type of referrals
screening programs. Time required from
Establish standard oncology referral till start
referral guidelines. treatment.
educate health care provider
in all facilities about
screening guidelines and all
non specific symptom and
sings of cancer and when to
refer to oncology facilities
Arrange especial oncology
referral office with adequate
facilities to receive all
oncology referral from other
services and direct it on time
to the right oncology unit.

5. Improve the standard of oncology Employ highly qualified Time to provide
centers at all levels. physicians, technicians and patient care.
nurses in all fields dealing Complaints trends.
with cancer patients and not Fewer requirements
depending on what is of referrals to
available since long time with centers outside the
poor knowledge. country
Increase the number of staff.
Quality inspection on regular
basis for the provided care.
Regular multidisciplinary
meetings at each institute

and between different
institutes.
Support education and
researches at all levels.
Provide the required Proper tissue
6. Support laboratories dealing with optimum reagents and handling facilitates
oncology cases. machines as well as highly proper patient care

qualified staff.
Quality assessment on
regular basis.
Determine the target A report indicating
7. Provide high quality screening units population and its target population Ensure funding
to be accessible to and cover the needs geographical distribution distributed in mechanism
of the target population
Determine the needs in term geographical area
Ensure long contracts of
of number of screening units, A report indicating
trained health
equipment and human the number of professionals
resources screening units
Establish a training program required and related (radiologists, technicians,
affiliated to an accredited equipment and surgeons) to ensure
international training centre human resources continuity
Contract of training
for health professionals
and quality control
related to early detection
affiliation to
and diagnosis ( mainly
accredited centers
radiographers, radiologists,
number of trained
surgeons, breast clinicians,
health professionals
nurses
number of defined
establish a quality control
indicators and
mechanism to ensure high
standard for quality
quality performance
control
provide the required
Number of orders of
equipment
purchase of
establish screening units
equipment
Number of
established
functioning
screening units

8. Monitoring and evaluation Search an organization A contract of
accredited in monitoring agreement with an
and evaluation of experienced
screening program organism
Make a contract of support Document for
and consultation evaluation
Determine all the required indicating the


indicators and standards indicators,
for monitoring standards, methods
Establish a system for data of data gathering.
gathering Number of soft ware
Establish a data base for all programs installed
in treating and
the related indicators
screening centers
Ensure periodic report for data gathering,
Ensure correction compilation and
mechanism issuing reports
Number of
evaluation reports
issued
Number of
correction processes
issued.

Partnership with related Number of declared
organizations and partnership Campaigns tailored to
institutions (women agreements. women culture, and
9. Women education and increase association, ministry of Amount of funds local context
utilization of services information, education, mobilized Communication with
communication, health A tested all representatives for
organization, …) Questionnaire different women
Funds raising and eliciting survey to elicit groups
support of educational knowledge, attitude Reaching out activities
programs and campaigns and barriers to subgroups and
Prepare a questionnaire to Number of minorities
assess knowledge, attitude campaigns and Modeling and
and barriers educational participation by
plan education programs activities political and social
and campaigns to meet Number of women leadership figures
needs and overcome educated Availability of invited to
barriers % of change in services (screening)
Reevaluation (post test) knowledge and
educational barriers
Number of women
utilizing the service
10. Organized advocacy group Find out from the Number of
community if there is enrollment.
prominent figure with Number of meetings
breast cancer survival.
Outcome from the
Form groups with clear
objectives and plans group
Arrange a regular meeting
for 4 months.

2020 STRATEGIC OBJECTIVE

Establish accessible and effective national screening and early detection programs in
each country.

Action Steps:
vii. Establish a Central Steering Committee, with representatives from each
participating country.
viii. Develop training programs for primary health care physicians and other
health care professionals.
ix. Develop standard plans for cancer center early diagnosis and screening.
x. Identify and review existing screening and detection services and create a
reliable screening infrastructure for specific cancers.
xi. Follow unified cancer screening selection criteria.
xii. Increase efforts to reduce obesity and improve nutrition and life style
(physical activity)

12 MONTH PROJECT

1. Develop a training program curriculum for primary care physicians and other
health care professionals about cancer prevention, screening and early detection.

2. To develop a manual for the process of establishing cancer care screening center
including steps, requirements and challenges.

FOLLOW‐UP PLAN
a. Determine the panel plans to sustain its momentum and continue its
work in the future. At least one follow up meeting should be planned in
the next 1 year. The meeting can be independent meeting or adjunct to
other conference or activity. Continued communication by e‐mails is
crucial to update members, exchange ideas and information about
related activities and news.
b. Annual Update will be done in a special session at the Annual AMAAC
meetings were relevant projects and updates from the panels will be
presented.
CONCLUSION

The panel members identified certain objectives and action steps to help
interested entities approach cancer screening and detection issues. The panel
will work on the 12 month projects and keeping in mind the strategic goal.

REFERENCES
1. Revised global burden of disease ( GBD) 2002 estimates, Geneva, World
Health Organization, 2002
2. Rastogi T et al. Opportunities for cancer epidemiology in developing countries
. Nature Reviews Cancer, 2004, 4: 909 ‐17. Revie
3. Ferlay J et al Globocan 2002: Cancer incidence, mortality abd prevalence
worldwide. Internationak Agency for Research om Cancer, Cancer Base No .5.
version 2.0, Lyon, IARC Press, 2004
4. National Cancer Registry. 1994 – 2005.
5. Ibrahim EM, Idrissi A, et al, Women’s knowledge and attribute towards
breast cancer in developing community: Implication of program
interventions. Results based on interviewing 500 women in Saudi Arabia. J
Cancer Educ 1991;6:73‐81.
6. Abdel Hadi M. Breast Cancer Awareness Campaign: Will it make a difference?
Journal of Family Community Medicine. 2006;13(3):115.118
7. Alam A. Knowledge of breast cancer and its risk and protective factors
among women in Riyadh. Annals of Saudi Med. Jul‐Aug 2006;26(4):272‐277
8. Dandash K, Al‐Mohaimeed A. Knowledge , attitudes and practices
surrounding breast cancer and screening in female teachers of Buraidah,
Saudi Arabia. International Journal of Health Sciences. January 2007;1(1):76‐
85
9. Alaboud L, Kurashi N. Barrierrs of breast cancer screening among PHHC
female physicians. 2006;4(5):ISN 148‐419
AVAILABLE RESOURCES
Type Affiliation
Individual, Governmental, Non‐ Contact Specific areas of
Entity Name Company governmental, Private Location / Information expertise and
Organization, Address Phone, Fax, Email interest
University Website

Ministry oh higher
education

Ministry of Health Organization Governmental Riyadh, Saudi
Arabia

Ministry of Planning Organization Governmental Riyadh, Saudi
Arabia

King Saud University University Governmental Riyadh Saudi King Abdullah
Arabia Institute House of
Experts
King Faisal
Specialized Hospital Organization Governmental Riyadh, Saudi
& Research Center Arabia

Bureau of Statistics Organization Governmental Riyadh, Saudi
Arabia

Cancer Registry Organization Governmental Riyadh, Saudi
Arabia
Charity
Organizations like: Organization Non‐ Governmental Riyadh, Saudi
Abdullatif Center, Arabia
Zahra Society

King Abdul‐Aziz
Hospital and MOH Jeddah, 0505613317 Breast Imaging
MOH Oncology Center. imanbaroum@yah Screening
Dr. Iman Baroum, oo.com Mammography
Consultant Breast Programs
Imaging and Head
of Radiology
Department
Ministry of Higher King Abdul‐Aziz Ministry of Higher Jeddah, 0505621784 Breast Imaging
Education University Education profasma@hotmail Screening
Hospital. .com Mammography
Prof. Asma Al‐ Programs
Dabbagh,
Head of Radiology
Department

Type Affiliation
University Website
Charity Dr. Samia Al‐ Sheikh Hussein Al‐ Jeddah, 0505626441 Breast cancer
Amoudi Amoudi Scientific Chair dr.samia_amoudi prevention.
Consultant @hotmail.com Breast cancer early
OB/GYN. detection.
Head of Sheikh
Hussein Al‐Amoudi
Scientific Chair

+249122118640 ORGANIZATION,RAI
MINISTRY OF GOVERMENTAL SUDAN, SING PROGRMS
HEALTH KHARTOU AND NATIONAL
M,NILE STREET REGISTERY WORK

SUDAN PRINT OUT ,HAND
INTERNATIONAL ORGANIZATION NON GOVERMENTAL KHARTOUM OUTS AND
DEVELOPMENT ,AMARAT AUDIOVISUALS C.DS
&RELIF BOARD STRRET 37

SUDAN MOBILE BREAST
WOMEN INITAVE ORGANIZATION NON GOVERMENTAL ,KHARTOUM,AM CLINIC,SIMINARAND
GROUP ART,STREETNO1 REFERED CLINICS
7

P.O Box 1499 Email: Cancer Screening
Bahrain Cancer Organization Non‐governmental AlAdliya, cancer@batelco.co Cancer Management
Society Manama, m.bh
Kingdom of Phone: (+973)
Bahrain. 17233080
Fax: (+973)
17233611

Organization Non‐governmental P.O.Box 26733 Email: Cancer Screening
Alsafa 13128, gffcckuwait@yaho Cancer Management
Kuwait. o.com
The Gulf Federation Website: Phone: (+965)
for Cancer Control www.gffcc.org 2530120
Fax: (+975)
2510137

Associate The Johns Hopkins Tel:(410) 955‐7095 Breast cancer
Professor of Outpatient Center. The Johns Fax: (410) 614‐ Screening
Dr.Nagi Khouri Radiology and Baltimore, Maryland Hopkins 7663 Director, Breast
Oncology Outpatient nkhouri@jhmi.edu Imaging
Director, Breast Center
Imaging Baltimore,
ryland .USA

Type Affiliation
University Website
Nottingham city National screening UK Consultant Breast
Dr.Robin Wilson hospital NHS trust. programme.UK Radiologist
London Breast Chairman of UK
institute Breast Screening
The princess Grace
Hospital
Family development Organization, Governmental Advocates for
foundation women needs;
women education
support
Organization Non Governmental Advocates for
Women Union women needs;
women education
support
Organization Non Governmental
Red Crescent Funding of
equipment
Dr. Mohammed A. Individual Ministry of Health Ministry of Fax: 9712 6324494 Program Radiologist
Latif National Breast Health – Abu Tel: 009712 Training on Screening
Screening Program Dhabi – 4474316 Mammography
PO Box 848
Dr. Mona El Sebelgy Individual Ministry of Health Ministry of Fax: 9712 6324494 Program Coordinator
National Breast Health – Abu Tel: 00971 – Planning and
Screening Program Dhabi – 6311135 evaluation
PO Box 848

Human Resources Development Inaugural Meeting Report


51
*on behalf of the Human Resources Development Panel Members

PANEL OBJECTIVES
Overview the global shortage of well trained health care professional.
Present regional initiative to develop human resources.
Present recommendations on how to address this issue.

PANEL MEMBERS

Facilitator
Dr. Abdulrahman Jazieh Chairman, Department King Abdulaziz Saudi Arabia
of Oncology Medical City
Panel Advisor/International Expert
Ms. Barri Blauvelt Professor Institute for Global USA
Health, University of
Massachusetts

Ms. Kathleen Houlahan Nursing Director, Children’s Hospital in USA
Patient Care Service Boston
Pediatric Oncology,
Stem Cell Transplant
Dr. Leslie E. Lehmann Clinical Director, Children’s Hospital in USA
Pediatric SCT Program Boston
Dr. Ghassan Abou Alfa Gastrointestinal Memorial Sloan USA
Oncology Kettering Cancer
Center
Dr. Ibrahim Qaddoumi Department of St. Jude Children’s USA
Oncology Research Hospital

Regional Panel Members

Dr. Ahmad Al Sagheer Chairman, Oncology King Fahad Specialist Saudi Arabia
Department Hospital
Dr. Ghuzayel Al Dawsari Consultant, Division of King Abdulaziz Saudi Arabia
Adult Hematology, Medical City
Department of
Oncology
Ms. Linda Balaam DCN, Nursing Services King Abdulaziz Saudi Arabia
Medical City
Dr. Amani Babgi Associate Dean, King Saud bin Saudi Arabia
Academic Affairs, Abdulaziz University
College of Nursing Hospital – Jeddah
52

Dr. Saleh Al Tuwaijri Director, Clinical Saad Specialist Saudi Arabia
Research Laboratory Hospital
Dr. Gaylani Abdallah Eltayeb Dean Aljazeera Univeristy Sudan
Dr. Adele Katiny Director, Continuing Ministry of Health Syria
Development Program
Marie Gretchen Datario datariom@ngha.med.sa +96612520088 Ext 14688
Fax: +96612520088 Ext 14691
Panel Guest
Name Organization
Harnan Cervales KAMC‐Riyadh
Sarah Jane Ford KAMC‐Riyadh
Julie Hillard KAMC‐Riyadh
Dr. Shahinaz Bedri Anfad University Women
Dr. Nafisa Abdelhafiez KAMC‐Riyadh
Ayda Hussesin Omar RTH
Nada Osman Yousef NCI Sudan
Catherine Dela Paz RMH
Josephine Trinidad RMH
Hazel Joy Alarde RMH
Kehride Dawadi RMH
Doodie Paglingayen RMH

ABSTRACT

Background: A diverse group of individuals from different countries,
backgrounds and expertise formed a human resource development panel to
develop recommendations on how to improve the human resources related to
cancer care as part of the Initiative to Improve Cancer Care in the Arab World
(ICCAW).

Methods: The panel members completed an assessment tool including
situational analysis, objectives, recommendations with action steps and
indicators and available resources to support the objectives of the panels. The
input was compiled and consensus was reached about the final
recommendations which are included in this report.

Results: There were uniform agreement on the need to have more
oncology health care workers (HCW) including physicians, nurses and other
support staff. Various recommendations about training programs both at
undergraduate and post graduate levels were suggested.

Conclusion: The Human Resources Development Panel put forth
recommendations and other useful information to help countries in the region
improve on their human capital for cancer care.

53
INTRODUCTION

Health care manpower is a crucial component of health care system. Human
resources development issue including training, recruitment and retention is a
major concern for all health care organization all over the world including the
developed countries. (1,2,3)

The shortage of staff is more pertinent to the oncology field not only in physicians
and nurses but also for all support staff and allied health science workers such as
psychologist, social workers, dieticians, radiation therapists and technologists, etc.

The staff shortage is more prominent in the developing countries which are
afflicted by major challenges including limitation of resources at various levels.

Furthermore, the limitation of the human resources in the developing countries
does not reflect only the lack of adequate number of staff in particular disciplines;
but also lack of adequate training, qualifications and experience of many of the
existing staff involved in cancer care.

The development of human resources should be considered an integral
component to any future plan to improve cancer care anywhere and at any level.

Due to its importance, the International Union Against Cancer (UICC) included
objectives related to human resources in its World Cancer Declaration(4). For the
2020 targets, UICC included 2 targets related to this matter. One states: “the
number of training opportunities available for health professional in different
aspects of cancer control will have improved significantly”. And the second states:
“Emigration of health workers with specialist training in cancer control will have
reduced dramatically”. (UICC World Cancer Declaration)

The purpose of this report is to highlight issues related to oncology human
resources development in the Arab Countries and to put forth strategic
recommendations to improve human resource area in the region.


Panel Formation
As part of the Initiative to Improve Cancer Care in the Arab World, a Human
Resources Development panel was formed from individual involved in the cancer
care in the region in different areas and background.

Panel Objectives:
To review the global shortage of well trained health care professional.
To present regional initiative to develop human resources.
To present recommendations on how to address this issue.

54
Initial Assessment and Recommendations Tool (IART):

IART was developed to include the following:
a.) To conduct a brief situation analysis including challenges and strengths.
b.) Provide strategic recommendations to address certain objectives including
specific action steps and indicators.
c.) Specify a doable objective to be achieved in the next 12 months.
d.) Compile a list of available resources anywhere in the world which can provide
support and help to the region in this project.


Arab countries span over a large geographical area with heterogenous
socioeconomical and political characteristics.

However, these are common grounds among the countries of feeling belonging
to one nation with common cultural and historical background.

In order to form an idea about human resource situation in these countries, the
panel members completed the initial assessment tool including situational
analysis. The findings of the situational analysis can be summarized as follows:

1. Strengths and Success:
The region has witnessed remarkable progress in the field of oncology
over the recent years. The following are some of these advances:
1.1. Emergence of multiple state‐of‐the‐art health care institutions
with advanced cancer care facilities.
1.2. Establishment of multiple new academic institutions with health
care education opportunities.
1.3. Creating many training opportunities both internally and abroad
and developing training programs.
1.4. Development of continuous medical education programs and
requirements and connecting with license renewal in some
countries.
1.5. Conducting numerous educational and scientific symposia locally,
regionally and internationally and increased participation in
international scientific meetings and activities.
1.6. Emergence of professional scientific societies or associations.
1.7. Development of collaborative activities with various academic
institutions in Europe and North America to enhance professional
and programmatic growth.
1.8. Enlisting the help of international organization such as WHO,
UICC, AEIA to help develop certain expertise
55

2. Challenges/Weaknesses
2.1. Stark and obvious shortage of skilled and well trained manpower
in most countries.
2.2. Maldistribution of expertise and concentration in major cities.
2.3. Health care worker migrations.
2.4. Lack of adequate postgraduate training and continuing educations
in some countries.
2.5. Lack of educational and training programs for many disciplines
especially non‐physicians such as nursing and other support staff.
2.6. Lack of strong institutional collaboration in development of HCW.
2.7. Lack of structured mentoring programs and mentoring culture.
2.8. Poor cancer care infrastructure in some countries impedes the
possibilities of training staff properly.
2.9. Limited resources allocated for Human Resources development.
2.10. Ambiguity of cancer burden in the region due to lack of accurate
reliable epidemiological data to estimate the actual needs of
manpower.
2.11. Lack of registries for manpower in each.
2.12. Cultural diversity of HCW in some institutions in some countries.

RECOMMENDATIONS
The following table includes the strategic recommendations by panel members
in addition to specific action steps needs to be taken to achieve the objectives.

Measurable indicators were identified to help determine whether the goal is
achieved or not.
Table 1: Panel Recommendations

Objective 1 1 Develop Fellowship Programs in the 1. Number of submitted
Train highly specialized and skilled fields of Medical Oncology, proposals
physicians in all oncology related Hematology, Pediatric Hematology
subspecialties Oncology, Gynecology Oncology,
Radiation Oncology, Palliative Care,
Surgical Oncology, etc.
2 Submit the programs for accreditation
from Arab Board and local Health 2. Number of accredited
Specialty Boards fellowship programs
3 Establish training programs in
different major hospitals
4 Establish affiliation with advanced 3. Number of trainees enrolled in
centers in North America and Europe this program
5 Establish sponsorship plan for trainees 4. Satisfaction and performance
of this program

56

Objective 2 1. Checkout interested 1. Number of organizations
Develop a committee from all organizations countrywide. participating covering
representing institutions to work on 2. Choose or nominate countrywide
developing educational programs representatives from each 2. Number of programs
for different disciplines organization developed and accredited
3. Develop working groups by 3. Number of programs
discipline to work on implemented
educational program plans 4. Number of programs
4. Develop needs assessment on evaluated
educational programs to find 5. Number of programs
out what exist. disseminated
5. Develop consensus on
proposed educational
programs per discipline
6. Start implementation process
in these organizations or select
a center in each city to
implement
7. Evaluate the impact of
implementing the educational
program
8. Disseminate the committee
plans and findings around the
country.

Objective 3
Developing post graduate 1. Create a policy for required 1. Number of programs 1. To be done at the level of
continued education, training and skill development. created. Ministry of Health is term
development program for health 2. Establish mechanism and 2. Number of people who of setting the
care professional. infrastructure to implement went through programs. requirements. Hospital
the program. 3. Compliance rate with with adequate resources
3. Mandate the requirement to program requirement. and expertise can develop
maintain licensures. these programs to be
4. Create individual practitioner accessible by Health Care
profile. Professional.

Objective 4
Develop a mentoring program for 1. Train senior physicians and
physicians. potential mentors with 1. Number of formal
mentorship skills. mentoring programs.
2. Develop local and regional 2. Number of mentees
mentoring programs. helped.
3. Create a mentoring network of 3. Impact on Mentees.
experienced physicians to
provide guidance to junior
professionals.
4. Conduct a career development
workshops for professionals.
57

Objective 5
Promote the growth of oncology 1. Establish a council for medical
support specialty services specialties development. 1. Number of accredited
2. Develop Training Programs in Programs
the fields of pathology 2. Number of trainees
assistant, advanced nurse enrolled in this
practitioner, general program
practitioner in oncology,
coordinator, navigator
function
Objective 6
Promote the development of 1. Using professionals in 1. Number of managers and 1. Evaluate the cost
interdisciplinary team for cancer advanced roles practitioners to support effectiveness of team
care 2. Maximizing the knowledge, practice changes arrangement and their
skills and judgment of the impact on patients
entire care team outcome
3. Projects to support the
development of innovative
HR team for cancer care

Objective 7
Advance the level of cancer care 1. Establish a CME HemOnc 1. Mortality and morbidity
and measure it against the western body data
standards 2. Establish an incentive for an
open access tumor board
facility
3. Establish a second opinion
expert panels to provide
unique advice in difficult
cases
Objective 8 1. Create professional 1. Number of professional
Create resources and facilities for development plans development programs
all healthcare professionals 2. Develop center of excellence created and utilized
in research and education 2. Number of researches
3. Encourage national and conducted
international conferences 3. Number of articles
participation/ representations published
4. Number of national
conferences participation/
representation
5. Number of international
conferences participation/
representation
Objective 9

Improve the image of the Nursing 1. Develop a task force 1. Pre public opinion
Profession committed to improving the survey to capture
image of nursing throughout attitudes and belief
the Arab world. towards nursing
2. Develop image and media profession and roles.
campaigns to illustrate the 2. Satisfaction surveys
impact nurses can have on related to nursing care
influencing patient outcomes. created and completed
3. Develop media campaign to by patients, physicians
highlight accomplishments of and general
nurses. population.
3. Number of nurses
enrolled in college level
education programs.


Objective 10
Empowering NURSING 1. To be included in MDC
meetings and decision
making
Objective 11
Improve Human Resource 1. Establish a program within 1. Number of nurses with and
Department Human Resources that with out previous experience
encourages entry into nursing that enter into the nursing
roles by individuals with and field.
without previous experience
in the field.
2. Recruit educated nursing 2. Number of organizations that
work force with emphasis hired nursing work force with
based on baccalaureate baccalaureate education
education.
3. External Candidate 3. Number of nurses hired with
Recruitment of diverse diverse backgrounds.
Associate Degree Nursing Number of organizations that
(ADN) Graduates with provides financial support and
planned advancement to incentives to those that
baccalaureate. (Bridge pursue a nursing career.
Program ADN‐BSN
facilitation)
4. Outreach to individuals with
diverse backgrounds to
consider nursing as a career
and enter the field.
5. Provides financial support
and incentives to pursue and
continue nursing education.
6. Train nurse in areas of human
resources.
7. Provide nurse recruiter with
skills to identify motivated
workers to strengthen the
organization’s position as a
national leader in pediatric
oncology nursing.

Objective 12
Establish a student career 1. Institute a Student Career 1. Number of students enrolled
opportunity program. Opportunity Outreach her per year in the SCOOP
Program(SCOOP) program

Objective 13 1. To develop future
Establish an unrestricted endowed 1. Write a proposal that 1. Set‐up a list of benchmarks: relationship between
program for education, clinical care, delineates the mutual number of exchange faculty, institution in the Arab
basic science projects, and tissue interests and goals of the two fellows, tissue procurement World and US or European
procurement joint projects among institutions. projects, etc. leading institution.
others.
Objective 15 1. Develop a database work group 1. Number of participating
develop a national database system among organizations organizations
standardized in all represented 2. Design a standardized template/ 2. Number of database template
institutions program to be used in all developed /specialty
participating organizations 3. Use of unified EMR by
3. Collaborate in unifying access in organizations
which EMR to be viewed by all
organizations


Objective 16 1. Develop programs to train 1. Number of program
Involvement of Primary Care primary care physicians and established.
others about cancer prevention, 2. Number of physicians trained
screening and early detection 3. Long term impact on stages of
and follow‐up of cancer patients cancer at diagnosis.

THE YEAR 2020 SUMMARY OBJECTIVE:
The following objective and action step was selected for the 2020 by the Human
Resources Development Panel:

Substantially improve human resource capacities in all professions aligned to
Supporting goals for comprehensive cancer care

Action Steps:
1. Increase the number of academic programs for various disciplines related
to cancer care.
2. Establish continuing education, training and development programs for
practicing professionals.
3. Improve practice standards to enhance professional satisfaction, staff
recruitment and retention, and ultimately improved cancer patient
outcomes.
4. Improve professional, academic and community awareness of the need
for qualified experienced cancer care professionals and the added value
they give to the quality of cancer care.

NEXT 12 MONTH PROJECT
Table 2 includes suggestion of doable projects that can be achieved over the next 12
months.

Table 2. 12 Month Project for Human Resource Development

Objective Action Steps Suggested Required Other Timeline
Responsible Funding/Source Required
Person/Entity Resources
1. Develop 1. Develop Education Interested Yes. 6 – 12 months
postgraduate working group. individual Government
program 2. Communicate (See below Societies
proposals for with accrediting objective 3) Hospital
Physicians, agencies.
Nurses and
other disciplines
2. Develop Identify topics Interested Publishing 3 months
Oncology HR Identify experts individual expenses, select expert
Resource Compile topics (see below identify 3 months
Manual Publish (online, objective 3) sponsors. collect
other) manuscript
3 months
review and
edit
3 months
publishing
3. (Related to Check out
Objective 1 and interested
2) Develop a organizations
committee from countrywide.
all representing Choose or
institutions to nominate
work on representatives
developing from each
educational organization.
programs for Develop working
different groups by
disciplines. discipline to work
on educational
program plans.
Develop needs
assessment on
educational
programs to find
out what exist.
Develop consensus
on proposed
educational
programs per
discipline.
Develop program
proposals.
Submit proposals
to accrediting
body.

FOLLOW‐UP PLAN
Determine the panel plans to sustain its momentum and continue its work in
the future. At least one follow up meeting should be planned in the next 1
year. The meeting can be independent meeting or adjunct to other
conference or activity. Continued communication by e‐mails is crucial to
update members, exchange ideas and information about related activities
and news.
A working group will be formed to address the 12 months project with close
follow up with all involved.

CONCLUSIONS
Human Resources Development faces many challenges in the Arab World in spite
of recent strides forward in this arena. This report include certain
recommendation that may help in interested parties improve the situation of the
human resources in the region which will be translated into improving the care of
cancer patients.

REFERENCES

1. Sheldon GF, Ricketts TC, Charles A, et al: The global health workforce
shortage: role of surgeons and other providers. Adv Surg 42:63‐85,
2008.
2. Oncology Nursing Society: The impact of the national nursing shortage
of quality cancer care. Oncol Nurs Forum 34(6):1095, 2007.
3. Kresl JJ, Drummond RL: A historical perspective of the radiation
oncology workforce and ongoing initiatives to affect recruitment and
retention. J Am Coll Radiol 1(9):641‐8, 2004.
4. www.uicc.org/declaration
Table 3. AVAILABLE RESOURCES FOR HUMAN RESOURCE DEVELOPMENT

Entity Name Type Individual, Affiliation: Location / Address Contact Information: Specific areas of
Company, Governmental, Phone, Fax, Email, expertise and interest
Organization, Non‐ Website
University governmental,
Private
Ministries of Various
Health
Medical and Organization Private Syrian syndicate of +963112216332 Health education,
Pharmacist physician +963112224256 donation, specialized
Association pharmacist consultants, cancer
prevention
National and Individual, Company, Governmental, Aleppo University Scts‐sy.org Tobacco Research
International Organization, Non‐
research centers University Governmental,
e.g. Center for Private
Tobacco Research
Ministry of Higher Universities Governmental, Aljamarek ST, Moh.gov.sy Increase residency
Education Private Damascus Syria training position and
programs, research
development
Saudi Commission Organization Non Governmental Riyadh http://arabic.scfhs.org.sa/ National Accreditation
for Health (National)
Specialties
National Organization Non Governmental USA http://www.NCCN.org/ind International resource
Comprehensive (International) ex.asp for Cancer Care
Cancer Network
NCCN
National Cancer Organization Non Governmental USA http://www.cancer.gov International resource
Institute NCI (International) for Cancer Care
Oncology Nursing Organization Non Governmental USA http://www.ons.org International resource
Society ONS (International) for Oncology Nurses
American Organization Non Governmental USA http://www.aahpm.org International resource
Academy of (International) for hospice and
Hospice and palliative care HCP
Palliative Medicine
Hospice and Organization Non Governmental USA http://www.hpna.org International resource
Palliative Nurses (International) for hospice and
Association palliative care Nurses
National Organization Non Governmental USA http://www.naswdc.org International resource
Association of (International) for oncology and
Social Workers hospice and palliative
care Social Workers
Children’s Hospital Hospital Private 300 Longwood Ave Kathy Houlahan Pediatric Oncology
Boston Boston, MA 02115 Kathleen.houlahan@child Leadership
rens.harvard.edu Staff Education
EBP
Dana‐Farber Hospital Private 44 Binney St Kathy Houlahan Pediatric Oncology
Cancer Institute Boston, Ma Kathleen.houlahan@child Leadership
02115 rens.harvard.edu Staff Education
EBP
Tobacco Control Inaugural Meeting Report
Tobacco Control
Tobacco Control
Dr. Elsayed I Salim and Dr. Naghi El Saghir
*on behalf of the Tobacco Control Panel Members

PANEL OBJECTIVES
Describe the epidemic of tobacco use in the Arab countries in context of the
global picture.
Present the challenges and the barriers to tobacco control.
Present the ongoing initiatives for tobacco control in the region.
Present recommendations and future steps to contain the danger of tobacco
use.
PANEL MEMBERS
Facilitators
Dr. Elsayed I Salim Associate Professor of Tumor UICC Asian Regional Office for Cancer Egypt
Biology Control (APOCP)
Dr. Nagi El Saghir Head and Professor of Internal Department of Internal Medicine, Lebanon
Medicine American University of Beirut
Dr. Anthony B. Professor Dalla Lana School of Public Health, Canada
Miller University of Toronto
Panel Members:
Dr. Mushabab Assiri Chairman & Consultant King Fahad Medical City Saudi Arabia
Radiation Oncology Riyadh Military Hospital
Dr. Abdulrahman Theyab Medical Oncologist King Khalid University Hospital Saud Arabia
Prof. Alaa Kandil Professor, Clinical Alexandria School of Medicine Egypt
Oncology & Nuclear
Medicine
Dr. Ahmed Abdelwarith Consultant King Fahad Specialist Hospital, Saudi Arabia
Department of Oncology Dammam
Dr. Mohamed El Naghy Consultant, Adult Medical King Abdulaziz Medical City Saudi Arabia
Dr. Yousef Al Owlah Clinical Pharmacist King Abdulaziz Medical Saudi Arabia
City
Ms. Susan Volker Operations Administrator King Abdulaziz Medical City Saudi Arabia
Jazzylyn Rodriguez rodriguezja@ngha.med.sa + 96612520088 Ext. 14107/Fax: + 96612520088 Ext 14691
Guest Panel
Name Institution
Mr. Naif Alhamadi KAMC ‐ Riyadh
Dr. Khaled Qatamish KAMC, Riyadh, Saudi Arabia
Ms. Adele Katiny MOH / Syria
Ms. Nada Al Faraj NGHA Dammam, Saudi Arabia
Ms. Naeemah Al Qanbar NGHA, Dammam, Saudi Arabia
Dr. Kehnale Dawocher Riyadh Military Hospital
ABSTRACT

Background: Tobacco continues to kill and cause overwhelming diseases and impacts
upon worldwide health and economic conditions. Smoking is the leading cause of
deaths from cardiovascular diseases (1.69 million deaths annually), cancer (1.4 million
deaths), and chronic obstructive pulmonary diseases (970,000 deaths). About one‐
sixth of the Earth’s population smoke cigarettes. According to recent reports (1), if
present trends persist, tobacco will kill a billion people in the 21st century. However, in
numerous countries, public health officials, civil society organizations, and various
other support groups initiate policies and programs designed to reduce tobacco use. A
major milestone was the development of the Framework Convention on Tobacco
Control (FCTC) by WHO (2), the first international treaty to protect public health. From
2002 onwards, the Arab League Ministers of Health council meetings have had
tobacco control on its agenda. The Ministers have called upon Member States to
adopt unified legislation, developed by the technical committee of the League of Arab
States on tobacco control. Over the past two years a number of activities have been
conducted in the Arab world, with special focus on the demand side of the FCTC and
the Bloomberg Global Initiative to Reduce Tobacco Use started in 2007 (3). Many
important developments have taken place in tobacco control as a result of the human
and financial resources made available since then. This report aims to emphasize the
progress in the Arab countries during the past few years and at the same time identify
the needs for the coming period of tobacco control in the region.

Methodology: Because the legislation developed in the Arab countries was not as
affirmative as recommended by WHO policies, especially with regard to 100% tobacco
free public places and to the size of health warnings on tobacco packs, the present
panel initiated the potential for more work on the legislative front of tobacco control
at national level in all Arab countries. The methods adopted were: 1) Initial
Assessment Form distributed to members; 2) Discussion of strengths and challenges;
3) Reach final recommendations; 4) Validate available resources and, finally 5)
discussion on various projects needed in the region to promote tobacco control as a 12
month project.

Challenges and Results: those included the need for programs to show the negative
effects of smoking on general health, the need to have more public awareness
programs; to pay specific effort on smoking women and teenagers; to give attention
for other types of smoking (Shisha, gedo, cigars..etc) and to build a data base network
of research on the tobacco situation within the Arab countries.

Recommendations and Conclusions: the main final objective was the decrease of all
forms of tobacco consumption in all Arab countries.

INTRODUCTION
The goal of this panel is to highlight the main achievements and the future of tobacco
control in the Arab countries. Tobacco control in the region has gone through some
important developments during the last 2 decades. Although tobacco control was an
individual initiative adopted by few Arab States, there were no collective regional
efforts towards controlling tobacco up to date. More organized efforts were through
organizations such as the World Health Organization (WHO) in promoting the
Framework Convention on Tobacco Control (FCTC), and the League of Arab States
which adopted regional measures for tobacco control. Also The Bloomberg Global
Initiative to Reduce Tobacco Use started in 2007, which focused on 15 priority
countries, the highest prevalence countries in the world, among them, one Arab
country, Egypt, was represented. This gave some re‐enforcement to tobacco control in
the region. Also the growing momentum created by the FCTC negotiations resulted in
the involvement of key national level government and nongovernmental sectors from
the Arab League member states. The Arab region witnessed enhanced efforts for
developing regional legislation, with heavy involvement of 3 Regional organizations;
the Arab League, the Gulf Cooperation Council (GCC) and WHO Regional Office for
the Eastern Mediterranean Region (EMRO) located in Egypt (4). During the same
period, national efforts focused on strengthening the infrastructure for tobacco
control as never as before in many of the Arab countries.

The main characteristics of the FCTC negotiation period at the Arab regional level
were: 1) establishment of an Arab regional and national surveillance system for
tobacco control to obtain evidence‐based data on prevalence; documenting beliefs
related to tobacco use and characteristics of populations at both national and Arab
regional levels; 2) well established regional coordination between WHO, League of
Arab States and GCC; 3) national and regional legislation was subject to review and
development in a way that reflected the principles and experiences shared during the
FCTC negotiations; 4) confronting the tobacco industry by governmental and local
organizations. Following on that, in collaboration with the Centers for Disease Control
in Atlanta, tobacco surveillance became an important component for completing a
comprehensive profile for tobacco control. The Global Tobacco Surveillance System
started in the Arab Region with Jordan implementing the Global Youth Tobacco Survey
in 1999 in its pilot phase. Nowadays, the Global Tobacco Surveillance System has 3
more components that are being implemented all over the Arab Region. WHO/EMRO,
the GCC and the League of Arab States joined forces at Regional level to strengthen
tobacco control.

In 2001, WHO/EMRO released a report on the tobacco industry activities in the Region
(5). In the 2 subsequent meetings of the Ministers of Health of the GCC, 2 resolutions
were adopted which called upon Member States to monitor and stop any
collaboration with The Middle East Tobacco Association. Immediately after the
Consultation on litigation and public enquiries as public health tools, held in Jordan in
February 2001, a resolution was adopted at the next meeting of the GCC, held in Saudi
Arabia in January 2002 calling upon Member States of the GCC to explore litigation
possibilities. From 2002 onwards, the Arab League Ministers of Health council
meetings had tobacco control on its agenda. It called upon its Member States to adopt
unified legislation, that developed by the technical committee of the League of Arab
States on tobacco control. Although the legislation developed was not as affirmative as
recommended by WHO policies, especially with regard to 100% tobacco free public
places and to the size of health warnings on tobacco packs, it contributed to
cultivating the appetite for more work on the legislative front of tobacco control at
national level. The FCTC process was very powerful in that it paved the way for
legislative changes that were reflections of the intensively diverse discussions which
took place in the negotiation meeting rooms. Some of these legislative attempts were
far from being perfect or ideal when it came to the impact on tobacco control. For
example, in Qatar the law on tobacco control, adopted in 2002, indicated that the
health warning should be 25% of the trademark size, while it was meant at the early
drafting stages to be 25% of the pack size. Nonetheless, some major successes were
achieved, such as the total ban on advertising, promotion and sponsorship in both
Egypt and Qatar. During that period it was realized that, after the numerous FCTC
negotiation rounds, more attention should be given to various aspects of the FCTC.

The first tobacco control legislation adopted in the Arab area was in Egypt in 1981.
Though relatively weak, it represented the first step in a long fought battle in the
Egyptian Parliament which concluded in 2007. In 1993, draft legislation was introduced
to ban all kinds of tobacco advertising in the country, but the bill was undermined and
ultimately defeated through the efforts of the strong tobacco industry lobby (6). In
2007, the Health Committees in the Arab world approached WHO to support new
legislation aimed at bridging the existing gaps in tobacco control. The announcement
of Egypt as one of the priority countries in the Bloomberg Initiative project gave
impetus to this effort, and a drafting group was established to look into the
suggestions of the health committee. The Regional Office provided technical support,
and the suggested amendments were shared with the Health Committee. The drives
for legislation concluded with full adoption of the demand‐side measures of the FCTC.
However there are still some gaps in relation to each measure in most of the Arab
countries:

On the other hand, linking religion with health promotion has been one of the main
interests of the panel members in this breakout session. They agreed that religion has
a strong influence in the Arab Region as it is a part of the daily life. All religions plead
people to watch over their health, to avoid health hazards and risks and to elevate
their principles of sanitation. Recently, many activities have been undertaken in line
with this particularly by the WHO/ EMRO. One of the most important steps was the
publishing of the first edition of: The Right Path to Health; Health Education through
Religion; Islamic Ruling on Smoking in 1996 as an attempt to tackle tobacco use
through religion; the second edition of this publication was issued during the year
2000. Also the smoking forbidding laws and regulations were issued by The Vatican on
14 June 2002 (7), in Arabic and translated into English and Italian. Moreover, the
Council of Islamic Ideology declared tobacco use as an ‘un‐Islamic’ act (8). Also the
Islamic rulings on smoking were issued by the Libyan Arab Jamahiriya on November
2009 (9). Previously, "The Christian View on Smoking", was issued by the Coptic
Church in Egypt, posted on WHO website and printed as part of the World no Tobacco
Day 2000 advisory kit (10).

In summary, taking all together, although tobacco control departments and many
efforts have been established, the necessary technical capacities are not yet fully
developed in the Arab countries and the tobacco control infrastructure is still in its
infancy in most of the Arab league states. There is a need to engage and develop
subnational bodies, i.e. governorate and provincial level departments, to sustain the
tobacco control infrastructure. In parallel with the need to strengthen the
infrastructure technically, there is also a need to ensure its sustainability through
funding, as the tobacco control programs in all Arab countries are currently
underfunded. Direct financial support may be needed until the programs are able to
develop indigenous mechanisms for sustainable funding. Also there still a need to
strengthen the technical understanding of the members of the coordination teams by
more supportive regular meetings and training of the members at national level.
Further, subnational coordination has yet to be established. One more important point
is that the influence of the tobacco industry in undermining tobacco control legislation
is an ongoing challenge. The tobacco industry is well aware of the socio‐political
dynamics of most of Arab countries and has influential connections with national
decision makers. Approaches to overcoming this challenge include publicizing local
evidence of industry tactics and inculcating strong tobacco control leadership at the
national level.

In general, national and cultural perspectives need to be carefully considered in order
to translate the huge international developments in tobacco control to the countries
of the Arab Region. In deciding the way forward for tobacco control in the Arab
World, the momentum generated by the governmental and non‐governmental
organizations and by the WHO/EMRO and the Bloomberg Initiative at the national
level still need a brief analysis of the tobacco prevalence estimates and the tobacco
control situation in the Arab countries. This will highlight the complexity of the
socio‐political situation in the region. The achievements to date have provided some
countries of the region with firm ground on which to advance in different areas of
tobacco control. There is a great need to consider help to some of the other Arab
countries with lower economical situation which are not yet fully involved in tobacco
control. The evolution of efforts over the last few years has encouraged all partners to
continue a proactive and collaborative approach in the Arab countries.


Methods:
The panel members completed an assessment tool including situational analysis,
Objectives, recommendations with action steps, indicators and available resources to
support the objectives of the panels. The input was compiled and consensus was
reached about the final recommendations which are included in this report.

Panel Formation:
As part of the Initiative to Improve Cancer Care in the Arab World, the Tobacco panel
was formed from individuals involved in the cancer care in the region in different areas
and backgrounds.

Panel Objectives:
Describe the epidemic of tobacco use in the Arab countries in context of the
global picture.
Present the challenges and the barriers to tobacco control.
Present the ongoing initiatives for tobacco control in the region.
use.


a. Strengths and Success:
Many achievements and successes have taken place despite the major
challenges still facing the Arab countries in tobacco control, and they have
also created inroads that will help to bring about changes that are
long‐term, sustainable and will ultimately result in a cultural shift away
from tobacco use in the Arab countries.

Tobacco Control Directorates were established officially in many Arab
countries.
Pictorial health warnings on cigarette packs were implemented in many
Arab countries.
National coordination was strengthened between the Arab countries
through the creation of National Advisory Groups on Tobacco Control,
initiated by WHO in Egypt (EMRO).
Agreement has been reached to raise taxes on tobacco products; WHO
is currently supporting technical capacity development and analysis of
the taxation system in many Arab countries.
100% tobacco‐free public places were introduced comprehensively by
law that will expand the type of public places covered. This ban is also
supported by Royal orders to ban smoking in work areas (Saudi Arabia,
Oman, Qatar, Kuwait, Bahrain, Jordan, UAE) and by the ministries of
health in most other Arab countries.
A plan of action to free Egypt from tobacco in 5 years was approved
recently by the Egyptian National Democratic Party.
In Morocco, Chaired by Her Royal Highness Princess Lalla Salma, the
Lalla Salma Association against cancer (ALSC) was established as a
public utility, non‐profit organization, and one of the most active civil
society organizations in the Arab region in the fight against cancer and
tobacco use.
The Moroccan Parliament has recently approved strong legislative
amendments in its national tobacco control legislation. Tobacco control
is also a priority agenda in the national plan for prevention and control
of cancer (PNPCC).
Arab MOH antismoking programs.
Religious Islamic Fatwa against smoking and Christian laws forbidding
smoking.
Smoke‐free holy cities in Saudi Arabia.
Active antismoking charitable organizations.
The Saudi Cancer Foundation in cooperation with the friends of cancer
foundation have launched a campaign about smoking and lung cancer.
There are initiatives in some supermarket series of not selling tobacco.
Project to fight smoking by Egyptian Smoking Prevention Research
Institute (ESPRI), A Joint Egyptian /USA Applied Research Program
Funded by Fogarty/NIH
Stopping advertisements related to cigarette smoking in journals and
media.
Conferences to stop smoking and recommendations to ban smoking in
Arab countries.
Special day reserved to place fight smoking advertisements in all media
to ban smoking.
Designated rooms for smokers in hotels.

b. Challenges and Weaknesses
Restaurants and cafés are not yet included in the ban on tobacco use in
public places in most Arab countries.
A total ban on advertising is needed. Indirect advertising, especially
through the cinema, some media and street advertisements, remains
widespread.
The taxation increase is not yet implemented. Although the FCTC
legislation adopted the increase in principle, implementation was left to
the Ministries of Health and Finance, noting that any changes in
taxation require parliamentary or further governmental approvals. This
will entail additional legislation.
Pictorial health warnings are not yet fully implemented. The specified
pictorial health warnings to be placed on all tobacco products, did not
address Shisha or other tobacco packaging apart from cigarettes.
Cessation support services need further strengthening. Although there
are cessation clinics in Egypt, Jordan, Lebanon, Syria, Tunisia, Algeria,
and Morocco, nicotine replacement therapy is not used and thus the
effectiveness of the clinics is limited.
Poor implementation of royal and governmental orders.
Strong tobacco merchants and allies.
Easy availability of cheap tobacco products particularly to young
people.
Poor legal consequences for breaking smoking bans
Poor actions of passive smokers.
Spread of attractive Shisha coffee shops.
Not allocating enough money from the general health budget towards
cancer and health care.
There is a need for more programs to show the negative effects of
smoking on general health (the effect on the cardiovascular system, the
lungs, the stomach and all forms of cancer).
Needs to have more public awareness programs and research
improvement organizations.

RECOMMENDATIONS
Strengthen the work directed at raising tobacco prices/taxes.
Follow up the tobacco control actions in continued collaboration with
governments, nongovernmental organizations and other partners, and
with the active engagement of the public.
Provide data and technical support to undertake future legislative
amendments in tobacco control.
Promote engagement of the Arab Member States in challenging for
research grants by submitting project ideas and writing of project
proposals for tobacco control projects, and to provide technical support
for accomplishments of grant projects.
Conduct surveillance research on a standard basis and expand tobacco
control activities to cover more countries in the region; and assist
countries that need technical and/or financial support.
Bringing together standardized data across the Arab countries will help
support results‐based actions at regional and national levels.
Scale up implementation and enforcement of the total ban on
advertising that exists in some countries, and work with other countries
to adopt a total ban on tobacco advertising through modifying their
legislation.
Evaluate and fine tune existing pictorial health warnings. Although
pictorial health warnings have now been introduced in some countries
of the Arab Region, their impact needs to be evaluated.
Enhance smoking cessation activities at national level including youth
and women.
Monitor the tobacco industry, a very important area that should be
supported according to the guidelines by the Convention of Parties to
the FCTC.
Introduce Telephone Quit lines in most Arab states.
More collaboration with religious authorities in the Arab Region to
continue issuing religious fatwa and laws against tobacco in mosques
and churches.
Produce and broadcast smoking cessation series.
Employ collaborative internet bloggers to design and assess effective
ideas for tobacco smoking prevention in youth and adults in various
internet website.
Change the false good image of Shisha and stop it being used in
restaurants, coffee shops and hotels by law.
Oblige the tobacco companies to donate money to treat cardiac and
cancer patients and for research in Oncology.
Encourage NGOs to have antismoking campaigns and use charity to
combat cancer due to smoking.

2020 OBJECTIVE FOR TOBACCO CONTROL PANEL

Decrease all 1‐ Intensify public Journalists, internet
forms of tobacco awareness campaigns, bloggers, politicians
consumption in through the use of public
all Arab media and community
countries. education programs. Have to be supported by
research data and scary
2‐ Support enforcement Journalists, politicians, clinical findings for health
of anti‐tobacco legislation, NGOs and effect on economy
such as banning tobacco
smoking in public;
establishing a minimal legal
age for smoking, etc.

3‐ Advocate for Journalists, Politicians
legislation to increase
tobacco taxation and for
revenue from tobacco taxes
to be allocated to cancer
research. Journalists, internet
4‐ Intensify public bloggers, politicians
awareness campaigns,
through the use of public
media and community
education programs.
Journalists, politicians,
5‐ Support enforcement NGOs Have to be supported by
of anti‐tobacco legislation, research data and scary
such as banning tobacco clinical findings for health
smoking in public; and effect on economy
establishing a minimal legal
age for smoking, etc.
Journalists, Politicians
6‐ Advocate for
legislation to increase
tobacco taxation and for
revenue from tobacco taxes
to be allocated to cancer
research.

a. Conduct an assessment of the magnitude of tobacco consumption in
the Arab World and publicize it.
b. Develop a proposal for a road map to approach tobacco control at
different levels.

Action Steps:
1. Develop tobacco control steering committee.
2. Review existing anti tobacco initiatives
3. Establish communication with anti‐tobacco organizations and societies.
4. Write a strategic plan for tobacco control.

FOLLOW UP PLAN

• Determine the panel plans to sustain its momentum and continue its
work in the future. At least one follow up meeting should be planned in
the next 1 year. The meeting can be an independent meeting or adjunct
to other conference or activity. Continued communication by e‐mails is
crucial to update members, exchange ideas and information about
related activities and news.
• Annual Update will be done in a special session at the Annual AMAAC
meetings were relevant projects and updates from the panels will be
presented.

CONCLUSIONS
Tobacco control is one of the major public health areas in the Arab world that needs to
be addressed through multifocal collaboration at all levels of authority. Support for
tobacco control in the Arab World must be connected with a full picture of
collaboration, research data, surveillance and follow up programs. This initiative will
be instrumental in strengthening the Arab regional network of partners to bring about
much‐needed improvement in tobacco control across the globe. Although there has
been progress in many Arab countries in tobacco control programs, many gaps and
challenges remain to be faced. Bridging these gaps will greatly advance tobacco
control efforts in the Arab countries. The panel members agreed that the
recommendation points presented in this report are the areas of immediate priority in
the Arab region in general, and in each Arab country in particular. However, new
priority areas may emerge over time, and planning must be flexible enough to allow
for addressing emerging country needs.

REFERENCES

1‐ From the World Cancer Congress and the 13th World Conference on
Tobacco OR Health, held in Washington, D.C., in July 2006.
2‐ WHO Framework Convention on Tobacco Control, 21 May 2003
(http://www.who.int/fctc/en/index.html).
3‐ Bloomberg Initiative to reduce tobacco use (WHO).
(http://www.who.int/tobacco/communications/highlights/bloomberg/en/i
ndex.html).
4‐ WHO Eastern Mediterranean Regional Office, Egypt
(http://www.emro.who.int/index.asp).
5‐ "Voice of truth". WHO/EMRO 2001(
http://www.emro.who.int/tfi/voiceoftruth.pdf".
6‐ (As later shown by the industry documents released as a result of the
Minnesota tobacco litigation. For more information see the WHO report
Voice of truth (2001), which describes the role of the tobacco industry in
defeating the 1993 draft legislation).
7‐ The smoking forbidding laws and regulations. The Vatican, 14 June 2002
(http://www.emro.who.int/tfi/vaticaneng.pdf).
8‐ Dawn newspaper, Islamabad, Pakistan, 26 May 2000.
9‐ The Islamic rulings on smoking. The Libyan Arab Jamahiriya, November
2009 (http://www.emro.who.int/tfi/PDF/fatwa.pdf).
10‐ Mentioned in the WHO Report on the Global Tobacco Epidemic, 2009:
Implementing smoke‐free environments, and Global Adult Tobacco Survey
in Egypt , 28 January 2010 . ((http://www.emro.who.int/tfi/tfi.asp).

AVAILABLE RESOURCES

Type Affiliation
Individual, Governmental, Contact Information Specific areas of
Entity Name Company Non‐ Location / Phone, Fax, Email Website expertise and
Organization, governmental, Address interest
University Private
Eastern International WHO Member Cairo, Egypt Tobacco control
Mediterranean (United Nations) states WHO Framework
Regional office of the Convention on
World Health Tobacco Control
Organization

International Union International ‐ Member Geneva,
Against Cancer NGO agencies (cancer Switzerland
(UICC) societies)
Access to Cancer Care Facilities Inaugural Meeting Report



Dr. Rabab Diab
*on behalf of the Access to Cancer Care Facilities Panel Members

PANEL OBJECTIVES
Describe the current status of cancer centers.
Present the need assessment for cancer center.
use.

PANEL MEMBERS
Facilitator
Dr. Rabab Diab Outreach Program Specialist King Hussein Institute for Jordan
Biotechnology and cancer
Dr. Fady Geara Professor and Chairman, American University of Lebanon
Department of Radiation Oncology, Beirut
Dr. Ben Anderson Director of Breast Health Women’s Health Care Center UWMC – USA
Clinic SCC Roosevelt Facility
Dr. Abdulrahman Al Hadab Consultant, Radiation Oncology KAMC Riyadh, KSA
Dr. Ali Al Omari Consultant, Division of Pediatric King Abdulaziz Medical City Riyadh, KSA
Hematology Oncology, Dept of
Oncology
Dr. Ahmad Bardeh National Oncology Center Yemen
Dr. Rabab Diab King Hussein Institute for
Outreach Program Specialist Biotechnology and cancer Jordan

Junna Ibardolasa ibardolasaj@ngha.med.sa +96612520088 Ext 14069 / Fax: +96612520088
Ext 14691
Panel Guest
Name Organization
Silvia Rabadi HCAC
Hristiliana Georgieva KAMC ‐ Riyadh
Janet Vaughen KAMC ‐ Riyadh
Dr. Fatiha Gachi CPAC ‐ Algeria
Meann Binti Omar AKMICH ‐ Riyadh
Halimah Lazim AKMICH ‐ Riyadh
Dr. Iman Al Hazmi NOC
Dr. Fatiha Gachi NOC
Dr. Nagi El Saghir American University of Beirut Lebanon
Ben Anderson Fred Huctchinson Cancer Research Center

Name Organization
Cecilia Sepulveda WHO
Falah Al Khatib Tawam Hospital
Maha Alidri
Dr. Iman Baroum

ABSTRACT
Background
Access to high quality cancer care remains a top priority for all cancer patients in
the world. Issues related specifically to access to cancer care include concerns
about excessive wait times for primary/community and specialized/diagnostic
services throughout the entire cancer control spectrum ‐ prevention, screening,
diagnosis, treatment, quality of life and palliation. However, for cancer, the
problem extends beyond wait times to include the economic factors related to the
spiraling cost of the new generation of available technologies and treatments.
Inequality of access is also of concern particularly for those living in rural
communities and for vulnerable and marginalized populations.
There is wide spectrum of variation between 22 Arab countries in the access to
cancer care facilities, and this is due to the variation between Arab countries
economic level, political factors, health care systems, and availability of resources.
Methodology
The panel discussions combined a review of issues related to access to quality
cancer care facilities and an overview of current challenges and opportunities
existing in the Arab world that can affect access to cancer care facilities, with free
ranging discussions on priority objectives and projects. The primary objective of
the panel was to gather baseline information, identify the priority of the objectives
to be achieved within the next ten years and a project to implement within the
next 12 months. To guide the discussions, participants were provided with briefs
on the background and reports send by panel members prior to the meeting.
Results and conclusions
This report is the result of pre‐panel meeting reports and discussions during the
meeting. Panel members and participants were asked to look at these priorities
and identify top priority for the long term objectives and the 12 months projects
utilizing an evaluation tool. Participants identified objectives and projects that
seemed relevant to access to quality cancer care facilities.
From the discussions and inputs from the participants, it was clear that there is
lack of baseline information about the cancer care facilities in the different Arab
countries, so the first recommendation was to conduct initial assessment and
develop data base for the cancer care facilities.

INTRODUCTION
Access to care is a multidimensional concept. Access has been defined as “the timely
use of affordable personal health services to achieve the best possible health
outcomes” (Millman, 1993, #874). Access has been further defined in terms of levels,
where primary access represents gaining entry into the health care system, secondary
access refers to navigating through structural barriers once in the system (e.g.,
difficulty or delay in getting appointments, receiving continuity care, and difficulty
getting a provider on the telephone), and tertiary access captures the interface
between individuals and the system, including the ability of providers to understand
and address patients’ needs and socio‐cultural contexts (Bierman et al, 1998, #1335;
Lurie, 1997, #659; Lavizzo‐ Mourey and Mackenzie, 1996, #986). Perceived access –is
an individual’s perception that they have been able to obtain all the medical care that
they thought they needed another dimension of access to care (Beck and Schur, 1998,
#772). Finally, a key component of access to care is the linking of the process of
obtaining health care to the quality and outcomes of that care; this is often referred to
as “realized access” (Anderson, 1995, #402).
Individuals who are poor, have low educational attainment, or are members of racial
or ethnic minority groups tend to have poorer cancer outcomes than members of
other groups. This is supported by findings from the literature relating to different
aspects of cancer care, some of the factors that have been investigated as possibly
affecting access to optimal cancer care are:
• health insurance coverage and type of coverage;
• cost, including health insurance and out‐of‐pocket costs;
• attributes of the health care delivery system (e.g., geographic distribution of
cancer care facilities, lack of service coordination);
• attributes of individuals (e.g., lack of knowledge or misperceptions about
cancer prevention and treatment, linguistic or cultural attributes); and
• Attributes of health care providers (e.g., lack of knowledge about cancer
prevention and treatment, communication styles).
• The information gathered before the meeting and the recommendations made
by participants will be used as the basis for the development projects focused
on access to quality cancer care facilities.

Panel Formation
Panel attendees were 20 between facilitator, panel members, guests, and
international experts.

Panel Objectives:
Describe the current status of cancer centers.
Present the need assessment for cancer center.
Present recommendation on establishing Cancer Care facilities that
addresses the spectrum of cancer care (diagnosis – treatment)


INITIAL ASSESSMENT AND RECOMMENDATIONS TOOL (IART)

Situational Analysis Findings:

a. Availability of qualified staff (physicians, radiologists, nurses, and other
healthcare professionals)
b. The treatment modalities (surgery, radiation, and chemotherapy) are
generally available
c. In many countries, there is one or more Cancer Centers that provides all
treatment modalities and services for cancer care (surgery, radiation,
chemotherapy, palliative care, and psychosocial and rehabilitative
support; a bone marrow transplantation unit is also available)
d. With regards to the cancer patient’s treatment path, patients with
insurance are treated through providers in their insurance plan. For
example, RMS‐insured patients are treated in the RMS and employees
of KAUH are treated at KAUH. In cases where not all services can be
provided in an institution, patients are referred to other institutions
that can provide supplemental care.
e. Uninsured patients or patients whose insurance plan does not provide
cancer care (e.g. certain private insurance plans) also are covered for
receipt of cancer treatment through the MOH.
f. Fellowship programs developed in some countries.
g. Expertise from different countries from a round the world.
h. Available and easy access to communication facilities with expertise
around the world (i.e., internet, telemedicine, conferences)
i. Availability of resource
j. The government is working on establishing more cancer centers in
different countries.
k. Cooperation of non‐governmental organization in finding cancer care
services such as screening programs.

a. Brain drains outside some countries for the healthcare professionals
b. Data and studies on treatment availability, access and patterns of care
are few (reporting of treatment information through JCR is slowly
improving)
c. Comprehensive guidelines and adherence to the guidelines is not a
well‐documented or monitored process, and sometimes is dependent
on the treating physician or the institution.
d. Lack of standardized treatment guidelines

e. There is a scarcity of health economics and health services researchers,
and little effort to systematically collect healthcare data for the purpose
of conducting research. The absence of data limits the extent to which
the impact of drugs within the RDL on health and economic outcomes
the RDL can be studied
f. No primary Care Provider.
g. Limited access to information about available services.
h. Long distance to a cancer care facility
i. Limited access to information about available services
j. Limited access to health care providers in rural areas, especially
oncologists
k. Transportation limitations
l. Lack of knowledge and access to clinical trials
m. Different healthcare providers with no coordination in‐between them.
n. Lack of adequate comprehensive oncology centers
o. Lack of man power because the numbers of oncologists is not enough
p. Lack of resources
q. The access to chemotherapy is not enough
r. Lack of awareness among people so most of them presented with
advanced caners
s. Lack of global and realistic strategies and policies that includes for
governmental authorities, universities, institutes, health units, NGOs
and all potential players and stakeholders .
t. Lack of realistic priorities for the need of cancer management facilities
among other health needs .What is also tragic, is the lack of applying
priorities of the needed
u. Limited financial resources due to increase care expenses prevent
establishing facilities.
v. Lack of adequate well trained wrong over to staff new facilities.

RECOMMENDATIONS
Based on the discussions the following recommendations were suggested by the
panel:
• Mapping of existing facilities
• Mapping of existing resources
• Assessing cancer burden per country (or region)
• Assessing the services of existing facilities
• Verify overlap with other panels to avoid duplication
• Collect data, identify problems, and make recommendations


2020 Strategic Objective
Objectives Action Steps Indicators
Objective 1 Establish a panel of experts in the field Process indicators
Identify inequities in cancer tasked to make recommendations for • Term of reference for the team drafted
care services and resource priority setting and resource allocation in and approved
allocation in all Arab countries each country. • The team conduct the first meeting
Outcome indicators
• The team produce plan of action to
allocate resources in the Arab countries
Conduct mapping of cancer care facilities, Process indicators
services, manpower and resources in each • Survey tools drafted and tested
country Outcome indicators
• Map of the cancer care facilities produced
Determine appropriate resource allocation Process indicators
processes, e.g. program budgeting and • Proposal for each country produced
marginal analysis for each country • Assessment and analysis tools drafted and
tested
Outcome indicators
• A gap analysis report produced per
country
Establish standards for cancer care facilities Process indicators
in primary, secondary and tertiary settings Task force team established and first meeting
in each country, based on population need conducted
and geographic burden of disease. First draft of standards developed
Outcome indictors
Number of facilities applying the standards

The following table includes suggestion of a doable project that can be achieved over
the next 12 months.

Objective (Only one) Action Steps Suggested Required Resources Timeline
Responsible
Person / Entity
Conduct situation Identify experts in “all” Panel members • Project coordinator 1 month
analysis for cancer countries • Administrative support
care facilities Build a team to collect 1 month
mapping and assessment
information
Define criteria for cancer care Team of experts • HR (project manager; field 1 month
facilities and available cancer researchers; data manager;
care services data analyst; senior
Collect information on access 3 months
researcher; administrative
and hurdles in cancer care
support);
Start a database 3 months
• transportation costs;
• computers;
• office space;
• training workshop costs;
• stationary;

Objective (Only one) Action Steps Suggested Required Resources Timeline

Responsible
Person / Entity
Meet half way to assess • Transportation and 6 months
progress and perform accommodation
preliminary analyses • Cost of meeting halls
• Administrative support
Complete analyses in 12 • Research analyst 12
months and make • Data management experts months
recommendations for the
• Computers
Initiative group (then to
lawmakers!) • Office spaces
• Stationary

FOLLOW‐UP PLAN
• Add more panel members to assure good representation
• Each panel member shall prepare a list of experts from their countries
• Identify list of experts and call for the first meeting
• Develop detailed plan of action for the 12 months project

CONCLUSIONS
• There is lack of consistent reliable data that evaluate quality access to
cancer care facilities in Arab world.
• There is diversity in the quality of access to cancer care facilities between
Arab countries
• The first initial step is to develop map of available cancer care facilities

AVAILABLE RESOURCES
The resource list will include any individual or entity that may help as a resource to
the regions in the topic discussed. The documents should include the entity name,
affiliation, type of entity, contact information and areas of expertise. These entities
may include:
Type Affiliation
Entity Name Company Non‐ Location / Phone, Fax, Email Website expertise and
Organization, governmental, Address interest
University Private
King Hussein Institute Organization Non‐ Jordan‐ Amman‐11814‐Jordan P.O. Comprehensive
for Biotechnology and government Amman Box 144756 cancer care
Cancer Not for profit Tel. (+962‐6) 5511003 center and
Fax (+962‐6) 5549021 research for
biotechnology
and cancer
National breast Organization Non‐ Jordan‐ http://www.jbcp.jo National program
cancer program government, Amman to increase
Not for profit awareness and
early detection
for breast cancer
Jordan university University hospital Non Jordan‐ http://www.ju.edu.jo/medi Provide
hospital government Amman cal/hospital treatment for
cancer patient
including BMT
King Abdullah University hospital Non Jordan – http://www.kauh.jo Provide
University hospital government Irbid treatment for
cancer patient

REFERENCES
1
Access to Quality Cancer Care: Evaluating and Ensuring Equitable Services, Quality
of Life, and Survival report submitted by Mandelblant, J., Robin, K., and Kerner, J.

2
http://www.nap.edu/openbook.php?record_id=6467&page=47

Diagnosis of Cancer Inaugural Meeting Report

Diagnosis of Cancer
Diagnosis of Cancer
Dr. Abdulmohsen Kushi and Prof Asma Aldabbagh
*on behalf of the Diagnosis of Cancer Panel Members

PANEL OBJECTIVES
Present the challenges to laboratory and imaging diagnosis in the Arab
World.
Present recommendation to improve cancer care diagnosis capabilities in the
Arab World.

PANEL MEMBERS
Facilitator
Prof. Asma Aldabbagh Professor and Consultant in KAUH Saudi Arabia
Radiology
Dr. Abdulmohsen Al Kushi Consultant, Pathologist, Dept of KAMC Saudi Arabia
Pathology and Laboratory Medicine
Dr. Shahinaz Bedri Schools of Medicine & Pharmacy Ahfad University for Women Sudan
Dr. Talal Al Harbi Consultant, Division of Pediatric KAMC ‐ Riyadh Saudi Arabia
Hematology/Oncology
Dr. Ahmed Absi Consultant, KAMC ‐ Jeddah Saudi Arabia
Hematology/Oncology
Prof. Dorothy Makanjoula Section Head and Consultant, KAMC ‐ Riyadh Saudi Arabia
Division of General Radiology,
Department of Medical Imaging
Dr. Emdadeddin Raddaoui Consultant, Histopathology & KKUH Saudi Arabia
Cytology
Dr. Salwa Sheikh Consultant, Pathologist Dhahran Health Center of Saudi Arabia
Saudi Aramco
Hanan Eldessouki eldessoukih@ngha.med.sa +96612520088 Ext 14689 / Fax: +96612520088 Ext 14691
Panel Guest
Name Organization
Dr. Jehad Alshawi KAMC ‐ Jeddah
Dr. Rehan Mahmood KAMC ‐ Riyadh
Dr. Ahmed Badr NGHA
Dr. Nafisa Abdelhafiez NGHA
Dr. Ayda Mustafa Hussein KTH


ABSTRACT
Background: Several factors impact proper and efficient cancer diagnosis in Arab
World. The purpose of this initial exercise was to highlight, through various panel
members feedback, the major challenges and strengths of the cancer diagnosis in
several Arab countries through participating members in the Initiative to Improve
Cancer Care in the Arab World (ICCAW), and to provide recommendations to
improve cancer diagnosis.

Methods: Panel members were asked to list the strengths of the country which
enhance proper and efficient cancer diagnosis; the weaknesses or challenges that
hinder cancer diagnosis; and recommendations to improve cancer diagnosis in the
region. This was followed up by a meeting to discuss the situational analysis and
suggest strategic recommendations and formulate a 12‐month plan to improve
cancer diagnosis in Arab countries.

Results: Strengths reported included, in certain centers, availability of funding,
expertise, and continuing education opportunities. Challenges included affordability
and availability of diagnostic care facilities; greater need for expertise in certain
centers; lack of a unified system to ensure standardized cancer reporting.
Recommendations centered around enhancing funding for diagnostic facilities;
improving the supply of diagnostic tools; strengthening the workforce relevant to
cancer early detection and screening; and increasing patient/provider/healthcare
manager education. However, responses were focused on the perspective of one
Arab country, and more regional representation of the issues influencing cancer
diagnosis is required.

Conclusions: Various deterrents to effective and early cancer diagnosis will need to
be addressed as an initial (short‐term) mechanism. Further input from other
countries will assure the regional relevance of any recommendations put forth.


INTRODUCTION
Cancer screening and early detection is an essential step in wining the battle to fight
caner. Several great efforts to establish these screening programs were initiated in
various regions in Arab World. However, most of these efforts were based on short‐
term plan and usually underestimate the facilities available and existing health care
system. These programs don’t have well established communication data flow
among them.

Screening and early detection of cancer can’t be well established with inadequate
diagnostic care facilities. These programs are mandatory to go hand in hand. With
limited or inefficient diagnostic services, the screening plans will be unfortunately a
waste of effort and resources. The planner of screening programs should be aware of
the available resources of diagnostic care facilities. The availability should extend to
the human skills and equipments.

Furthermore, an efficient and adequate diagnostic services for cancer is the initial
step to start the battle of fighting cancer. If the fighter failed to identify properly the
enemy he will defiantly lose the battle or even harm innocents.

This effort is made to explore the challenges that face the cancer diagnostic services
in the Arab countries and provide a report that could help the health care planner in
these countries. Furthermore, it will provide a noble plan to work on achievable
objectives to be accomplished in a 12 months period.

METHODS
The panel objectives were specifically to describe the challenges of cancer diagnosis;
review the status of cancer reporting guidelines available in the Arab World; and
discuss options on how to improve cancer screening and early detection. Members
of the panel were asked to provide information from their respective countries’
perspectives. Specifically, panel members were asked to list the strengths of the
country, which enhance cancer diagnostic care; the weaknesses and needs, or
challenges that hinder cancer diagnosis; and recommendations to improve cancer
screening and early detection programs in the region. Finally, members were asked
to focus on those recommendations that could be implemented within a year and
identify the potential resources required to implement them, so as to develop a
short‐term action plan for the region to be implemented within a year after the
meeting.

Strengths
1) Increasing recognition of the importance of specialized radiologist in
the Oncology field.
2) The presence of multidisciplinary meeting in various areas of oncology
in the hospitals.

3) Lectures, workshops and conferences are frequently undertaken in

Oncology to promote self‐education.
4) Even though limited in number, availability of histopathological
diagnostic facilities.
5) Though limited in number, availability of laboratories that perform
ancillary studies (IHC, Molecular…)
6) While limited to major governmental facilities, availability of qualified
and experienced manpower.
7) While limited in number, presence of tertiary referral hospitals.
8) Presence of a national initiative for advanced training of medical staff
who can serve at different levels.

Weaknesses
1) Lack of Imaging policies, guidelines and supervision. Many of the
images produced in many hospitals are of poor quality which
obviously affects interpretation. This means that many cancers can go
undetected.
2) Lack of imaging equipment quality control and radiation protection
guidelines, subjects many patients, especially the young to
undesirable amounts of radiation.
3) Lack of well‐trained staff.
4) Inadequate number of specialized Radiologists to cope with the
workload.
5) Inadequate number of imaging equipment (particularly CT which is
the most used) to undertake the required workload. Endoscopic
Ultrasound, MRI and PET or SPECT CT are also grossly inadequate.
6) Poor demand management. In proper prioritization of cases requiring
radiological diagnosis.
7) Poor follow‐up system after diagnostic cancer detection.
8) Inequality of access to specialized radiological management. Some
patients present late following missed diagnosis by less competent
radiologists from remote areas.
9) Cultural issues causing lack of compliance to come for screening
program or to complete required examinations of follow‐up.
10) Lack of educational information amongst public in the region. They
tend to present late with the disease.
11) Lack of personal auditing amongst radiologists to improve
performance apart from the multidisciplinary meetings.
12) Ancillary , advanced techniques are not available and accessible in all
hospitals
13) Qualified pathologists and technologists are concentrated in few
major centers.
14) Primitive systems for unified National Reference Diagnostic Facilities
(example=regional reference labs)

15) Accessibility of advanced medical centers limited by bed availability
and delays in acceptance.
16) Lack of satellite clinics for referral centers
17) Underdeveloped "same day surgery centers" concept.
18) Lack of National guidelines for cancer diagnosis
19) Deficient in some laboratory tests and number of trained and quality
of staff in these kinds of lab
20) Fragmentation of services kingdom‐wide with no uniformity of care
for the same diagnosis in different centers.
21) Lack of quality assurance in diagnosis in particular pathology
diagnosis.
22) Inequities of access to medical care for diagnosis and treatment due
to economic and social causes.
23) Multidisciplinary teams for cancer care are not available in most
centers.

Table 1: Recommendations


1. Incidence of common
tumors
2. Prevalent age and gender
1. Improve diagnostic facilities
1. Reduction of Cancer Mortality 1. Mortality rate of certain tumors
2. Education
Rate 2. Diagnostic yield 3. Availability of screening
3. Improve treatment modalities
programs.
4. Availability of diagnostic
and treatment facilities.
1. Carefully control license granted by
Saudi Council of medical specialty
2. Re‐evaluate all current
histopathology specialists, namely
2. Making sure that practicing in private labs under the Annual review of Instant actions should be taken
Histopathologists, who report and supervision of the Saudi Council of pathology reports by authorities regarding
sign out oncology cases are aware medical specialty. that are referred to unsafe, unqualified
of components to be included in 3. Encourage solo pathologists to seek the referral qualified histopathologists, namely in
each report. second opinion in each difficult centers. private labs.
case.
4. Encourage using the approved
reporting guidelines by
international authorities (CAP…)
1. Introduction of ancillary techniques Percentage of labs
3. Improve current diagnostic (immunohistochemistry, molecular, with advanced

laboratories cytogenetics) diagnostic facilities
out of all labs
1. Involve media in cancer
2. Creation of cancer awareness Number of cancer
4. Improve patients and general weeks. patient who have

public education and counseling 3. Provision of qualified counseling received counseling
staff of all cancer patients.


1. Number of tests
performed in such
1. Asses the need for such centers
centers and
and their geographical presence.
whether or not it
5. Developing regional OR National 2. Economic feasibility study.
would be serving
“Reference” centers for diagnostics 3. Centralizing all related studies into
all the area it was
(especially reference Labs) those centers.
intended to serve.
4. Developing easy accessibility for
2. Efficiency of results
such centers.
reporting.

1. Coordinating within the existing 1. Regional
6. Developing National and maybe scientific organizations such an acceptance of such
regional guidelines for cancer effort. guidelines.
diagnosis 2. Gaining the support of 2. Educating Medical
governmental authorities in Staff about

that effort.
guideline.
3. Coordinating with
3. Updating the
International
guidelines
Organizations for such an
periodically.
effort (WHO)
1. Coordinating between different
1. Number of
referral centers such an effort.
7. Within each country, establishing patients benefiting
2. Opening the door for other
outreach programs for from such service.
interested physicians for “voluntary
underdeveloped areas (bringing the 2. Number of
work”.
expertise and technology for people physicians
3. Seeking the financial support of
who needed it) participating in
concerned entrepreneurs and local
such an effort.
businesses.
1. Lectures to schools and the public More public
at large. awareness. More
8. Increase cancer and risk factors Early cancer detection is
2. Refresher courses in Evidence‐ people coming
awareness for health care known to improve outcome,
based medicine in oncology to forward for such
professionals and the public. morbidity and cost.
professionals. screening and early
3. More involvement of the media. detection.
1. All hospitals must be issued with
licenses that allow them to image
patients for screening and for Early and better Treatment planning relies on
9. Standardization of Imaging
diagnostic work‐up. cancer detection accurate imaging assessment
Protocols for different cancers
2. Licenses maybe obtained by and staging. and staging.
passing quality control tests and
professional eligibility tests.
1. Referral Centers with
1. Different organizations (e.g.
more experienced
Universities, National Guard,
personal can significantly
10. Development of comprehensive Ministry of Health, etc) must
contribute to cancer
cancer imaging referral centers. combine efforts to designate
Excellent cancer outcome.
Referral Centers should be specialized referral centers,
diagnosis and 2. Communication facilities
equipped with the state‐of‐the‐art encourage team work and establish
follow‐up. transfer information
equipment, dedicated professionals excellent communication ports.
between professionals
and telecommunication services 2. Continuing medical education and
and patients.
training of health workers.
3. State‐of‐the‐art
3. Regular audits.
equipment allows faster



throughout and improved
images.
4. Audits improved
performance.
5. Research is important for
4. Research statistical and disease
information and enables
us to make specific
recommendations, e.g
best starting age for
screening.
Close supervision of radiation doses
given in all imaging procedures
especially to young patients. This can
be done by the availability of physicists
in radiology departments, who will Decreased incidence Excessive cumulative
11. Radiation Induced Cancer measure doses for different of cancer among radiation doses are risk
Prevention examinations. Clinicians must be individual exposed to factors for future
encouraged to revise the indications of radiation development cancer.
different radiologic procedures.
Radiology technologists must always
provide radiation protection to
patients as much as possible.
12. Common center for each
region to do all expensive high
technology tests whether
diagnostic for prognostic for
malignancies. Also list of highly
qualified pathologists to be
available for each region to use
for second opinion of difficult
cases.
Through collaboration and affiliation
13. Development of standard
with outside centers such as WHO and
guidelines to diagnose and treat
other cancer centers, with ongoing
cancer patients to be used by
updating of information and
physicians in all centers.
guidelines.
1. Education campaigns in schools for
self examination and
mammography for breast cancer
and for pap smears for cervical A member of
cancer. acquisition of these
14. Development of screening
2. Campaigns in different regions for machines within a
programs for breast and cervical
population awareness. year reduction of
cancer.
3. Calling women and teaching them waiting list for
about screening programs. Oncology patient.
4. Offering screening to all suitable
candidates visiting hospitals for
any reason.
Making solid case to Hospital
15.Provision of necessary
Authorities/Government or Non‐
imaging equipment: imaging
governmental bodies for the purchase
equipment: CT, MRI, PET‐CT, US
of these equipments.




16. Training of highly The number of machines
skilled and competent available/increase should
Same as the
Radiologist and Same as the examples given be noted. The quality of
examples given
Technologist in examinations should
Oncology Imaging improve.
Examinations of
Currently trained
cancer cases within
17. Prioritization of personnel should be
Discussion with department of the agreed time limit
investigation of encouraged on
Medical Imaging about e.g. 10‐14 days.
Oncology patients continuous
prioritization with an agreed limit.
including follow‐ups education/publications
Significantly
and self‐auditing.
improved waiting list


Ensure all cancer diagnostic testing in the Arab World is conducted following the
highest international standards and quality control regulations.

Action Steps:
1. Establish a Regional Steering Committee to oversee the regulation,
development and implementation of diagnostic standards.
2. Establish practice guidelines for referring physicians and radiologists.
3. Develop virtual national reference centers for cancer diagnostics.
4. Establish procedures in cancer centers that complex cases (such as
unusual case presentation or failure to respond to treatment) are
reviewed and discussed by a multidisciplinary team and resulting in a
written plan of care.


Objectives to be achieved within the 12 months plan
After the inaugural meeting and the discussion with the panel members, it was
agreed to present the following objectives as the targets of the panel to achieve.
• Generating a proposal to develop virtual National Reference center for
cancer diagnosis
• Establishment of quality control assessment strategy for equipment used in
cancer diagnosis
• Standardization of imaging protocols through guidelines.

Action Steps
• Working in a team to generate a proposal to develop virtual National
Reference center for cancer diagnosis to be presented to high
management of health care facilities in the Arab countries.
• Implementing this reference center at least in one country to be used
as pilot.
• Issuing check lists for equipment quality control requirements to
hospitals and medical centers, by qualified physicists.
• Encourage using the approved diagnostic protocols and reporting
guidelines by International authorities.

Follow‐up plan
A follow‐up plan will be determined after the first (inaugural) meeting. Panel
members willing to actively participate will be nominated to agree unanimously on a
follow‐up plan for the panel, including
a. Specific objectives both for the panel’s development and the agreed
upon 12‐month project
b. Activities or action items to be performed under objectives
c. Roles and responsibilities
d. Potential resources (financial, technical, other) to facilitate panel
activities
e. Deliverables for the panel
f. Indicators of panel progress
Limitations of exercise
With regards to the approach, an informal, qualitative approach serves as a useful
first step in trying to understand the current status of cancer diagnosis, and issues
existing specifically relating to cancer early detection. Nevertheless, a more rigorous
methodology will be required subsequently in order to quantify the extent to which
gaps in/barriers to cancer care exist.



At the present time, valuable information and useful recommendations were
obtained from [few] respondent panel members. Further information from other
countries participating in the ICCAW is missing and will be critical in creating a
comprehensive regional perspective.

Furthermore, an insufficient selection of resources was listed. Nevertheless, more
resources can be identified in the upcoming meeting.

AVAILABLE RESOURCES

Type Affiliation

Individual, Company Governmental, Non‐
Entity Name Location /
Organization, University governmental, Private
Address
Cancer Societies Organization Non‐governmental
World Health Organization Organization Non‐governmental
National Cancer Centers Network (NCCN) Organization Non‐governmental
Arab League Health Sector Companies Private


Overcoming the Challenges of Pediatric Cancer Care in the Arab World Inaugural Meeting Report
Overcoming the Challenges of Pediatric

Cancer Care in the Arab World

Overcoming the Challenges of Pediatric
Cancer Care in the Arab World
Dr. Reem Al Sudairy and Dr. Mohammad Jarrar
*on behalf of the Overcoming the Challenges of Pediatric Cancer Care in the Arab World

PANEL OBJECTIVES
Present challenges to laboratory and imaging diagnosis in the Arab World.
Present recommendation to improve cancer care diagnosis capabilities in the
Arab World.

PANEL MEMBERS
Facilitators
Dr. Reem Sudairy Division Head, Pediatric hematology‐ King Abdulaziz Medical Saudi Arabia
Oncology City‐Riyadh
Dr. Mohammad Jarrar Consultant, Pediatric Hematology‐ King Abdulaziz Medical Saudi Arabia
Oncology City‐Riyadh
Panel Advisors/International Experts
Dr. Raul Ribeiro Director, International St Jude Children’s Research Hospital USA
Outreach Program
Dr. Ibrahim Qaddoumi Director, Telemedicine/ St Jude Children’s Research Hospital USA
Consultant Pediatric
Hematology‐Oncology
Dr. Leslie Lehmann Clinical Director Pediatric Boston Children’s Hospital/Dana USA
Stem Cell Transplant Farber Cancer Institute
Program
Kathleen Houlahan, RN Nurse Manager, Boston Children’s Hospital/Dana USA
Pediatric Stem Cell Farber Cancer Institute
Transplant Unit
Dr. Hassan El‐Solh Director, King Fahad National King Faisal Specialist Hospital‐ Saudi Arabia
Children’s Cancer Center Riyadh
Dr. Wasil Jastaniah Division Head, Pediatric King Abdulaziz Medical City‐ Saudi Arabia
hematology‐Oncology Jeddah
Dr. Reema Al‐Hayek Division Head, Pediatric King Fahad Specialist Hospital‐ Saudi Arabia
hematology‐Oncology Dammam
Dr. Nisreen Khalifa Specialist, Pediatric Kuwait
Hematologist‐Oncologist
Dr. Hani Saleh Consultant, Pediatric Augusta Victoria Hospital‐ Palestine
Hematologist‐Oncologist Jerusalem
Dr. Khulood Al‐Saad Consultant, Pediatric Salmanya Medical Complex Bahrain
Dr. Naima Al‐Mulla Section Head, Pediatric Hamad medical Corporation / Qatar
Hematology‐Oncology Hamad General hospital
Dr. Iyad Sultan Consultant, Pediatric King Hussein Cancer Center Jordan


Dr. Oumaya Fawaz Head, Pediatric Hematology‐ Al‐Bairouni University Hospital Syria
Oncology Unit
Dr. Sherif Abu‐Elnaja Deputy manager/ Consultant, Children’s Cancer Center of Egypt
Pediatric Hematologist‐ Egypt (57357)
Oncologist
Dr. Nada El‐Haj Consultant, Pediatric National Cancer institute‐ Sudan
Hematologist‐Oncologist University Of Gezira
Dr. Fatiha Gachi Head, Pediatric Hematology‐ Pierre & marie curie center Algeria
Oncology
Dr. Laila Hessissen Consultant, Pediatric Morocco
Dr. Nada El‐Haj Consultant, Pediatric National Cancer institute‐ Sudan
Hematologist‐Oncologist University Of Gezira
Dr. Fatiha Gachi Head, Pediatric Hematology‐ Pierre & marie curie center Algeria
Oncology
Dr. Laila Hessissen Consultant, Pediatric Morocco
Junna Ibardolasa ibardolasaj@ngha.med.sa +96612520088 Ext 14069 / Fax: +96612520088 Ext 14691
Panel Guests
Name Organization
Sarah Jane Ford KAMC ‐ Riyadh
Linda Balaam KAMC ‐ Riyadh
Dr. Talal Al Harbi KAMC ‐ Riyadh
Huda Areishi KAMC ‐ Riyadh
Nada Osman NCI ‐ Sudan
Islam Elgasim MOH ‐ Sudan
Yaseer Abulrazzak AMCC ‐ Syria
Feryal Said KAMC ‐ Riyadh
Ali Al Shehri KKUH
Afshan Ali KFSHRC
Sarah Jane Ford KAMC ‐ Riyadh
Linda Balaam KAMC ‐ Riyadh
Dr. Talal Al Harbi KAMC ‐ Riyadh
Huda Areishi KAMC ‐ Riyadh


ABSTRACT

Background: A diverse group of pediatric oncologists from different countries,
backgrounds and expertise formed a pediatric cancer care panel to develop
recommendations on how to overcome challenges to pediatric cancer care in Arab
countries as part of the Initiative to Improve Cancer Care in the Arab World (ICCAW).

Methods: The panel members completed an assessment tool including situational
analysis, objectives, recommendations with action steps and indicators and available
resources to support the objectives of the panel. The input was compiled and
consensus was reached about the final recommendations which are included in this
report.

Results: There were uniform agreement on the need to have more training programs
in pediatric oncology for physicians, nurses and other support staff. The panel
members also agreed on the need to unify treatment guidelines for most common
pediatric cancers in the region and establish regional infrastructure for research in
the field. Various action steps on how to achieve these goals and improve access to
modern care for children with cancer were suggested.

Conclusion: The pediatric cancer care panel put forth recommendations and other
useful information to help countries in the region improve pediatric cancer care.

INTRODUCTION

Pediatric population constitutes a large proportion of the society in Arab countries
when compared to the West. Pediatric patients with cancer present unique
challenges and opportunities. Access to specialized pediatric oncology care is a major
issue in many countries. Pediatric cancer has high cure rate if diagnosed and
managed properly. Children with cancer require multidisciplinary care by other
pediatric sub‐specialists; whose presence is often lacking. Chemotherapeutic agents
used to treat pediatric cancer are much less expensive than drugs currently used in
adults. Pediatric oncology treatment strategies is by large protocol driven, which
presents both an opportunity and challenge


Panel Formation

As part of the Initiative to Improve Cancer Care in the Arab World, a pediatric
cancer care panel was formed from individuals involved in the pediatric cancer care
in the region from different areas and backgrounds.


Panel Objectives
1. Present special challenges to pediatric cancer care in Arab countries

2. Discuss recommendations to improve pediatric cancer care in Arab countries

Initial Assessment and Recommendations Tool: (IART)

e.) To conduct a brief situation analysis including challenges and strengths.
f.) Provide strategic recommendations to address certain objectives including
g.) Specify a doable objective to be achieved in the next 12 months.
h.) Compile a list of available resources anywhere in the world which can provide


Strengths

• Presence of at least one specialized pediatric oncology unit in almost each
Arab country, which is staffed by one or more pediatric oncologists.
• Protocol driven treatment strategy for pediatric cancer patients in most
countries.
• Government support for treatment cost in most countries.
• Presence of multidisciplinary care in several countries.
• Presence of sub‐specialized teams and disease specific tumor boards in some
countries.
• Presence of sophisticated diagnostic labs & radiology facilities with access to
international labs in several countries.
• Presence of advanced treatment modalities such as stem cell transplant in
several countries.
• Presence of infrastructure for data collection and research in some countries.
• Presence of pediatric palliative care programs in some countries.
• Presence of national pediatric oncology fellowship programs in some
countries.
• Collaboration with international experts in many countries.
• Availability of specialized pediatric oncology nursing care n several countries.
• Presence of national pediatric oncology societies in several countries.
• Presence of support groups and charity organizations focused on pediatric
cancers in some countries.


Challenges:

• Lack of pediatric oncology fellowship programs in several countries.
• Shortage in the number of physicians specialized in pediatric oncology in
most countries.
• Weak or absent coordination between pediatric oncology program within
each country and with other programs in the region.
• Shortage in nurses with expertise in pediatric oncology in most countries and
lack of empowerment.
• Lack of national or regional treatment protocols.
• Concentration of pediatric oncology centers in major cities.
• Lack or shortage of sophisticated diagnostic modalities in several countries.
• Major shortage in funding pediatric oncology treatment in some countries.
• Difficulty in accessing pediatric oncology centers for non‐citizens in most
countries and lack of funding of such care if access is available.

• Substandard treatment for adolescents with cancer because of age limits in
most countries, as a result adolescents are treated by adult oncologists.
• Lack of expertise in dealing with emergencies by primary care physicians for
children with cancers who live in peripheral and remote areas.
• Late referral for pediatric cancer cases to specialized centers resulting in late
diagnosis and presentation in advanced stage in some countries.
• Shortage of drugs necessary to treat children with cancer in some countries.
• Inadequate number of beds resulting in long waiting time for children with
cancer in many countries.
• Lack of multidisciplinary approach and in other supporting services
(personnel &equipment) in several countries.
• Lack of public awareness and negative attitude towards obtaining treatment
in specialized centers.
• Weak research activities related to pediatric oncology and primitive if any
national or even hospital databases.
• High rates of treatment abandonment in few countries.
• Absent or weak pediatric palliative care programs in most countries.
• Lack of sub‐specialization among pediatric oncologists.
• Lack of trust in local services and preference to seek treatment out of the
country in some countries.
• Shortage in the number of facilities that provide sophisticated treatment
modalities such as radiation therapy, stem cell transplant and advanced brain
surgery.


RECOMMENDATIONS

Objectives Action Step Indicator Comment
1. Unifying treatment Establishing disease specific Number of disease Each working group will
guidelines for the most working groups across the specific treatment discuss guidelines to be
common pediatric cancers in region thus enhancing sub‐ guidelines /protocols used for each disease
the region, by agreeing on specialization/cooperation agreed upon in the entity
national/regional protocols among pediatric oncologists region
for common pediatric in the region.
cancers.

2. Working with governments, Form a group of pediatric Number of countries
Charities and insurance oncologists in each country that has full coverage
companies to assure full that will prepare a proposal for childhood cancer
financial coverage for the to the government and treatment
treatment cost for any child charities to fund cancer
with cancer in the Arab care for children
world.

3. Educate primary health care Holding regular courses / ‐Number of courses Such courses will be
providers in the peripheral workshops in early conducted per year conducted in major cities
areas about early detection detection and emergency ‐Number of providers by major centers, who
and emergency management for pediatric who attended these will alternate in
management for pediatric cancer for primary health courses in every organizing such courses
cancer. care providers from country
peripheral areas
4. Establishing national Forming a regional ‐Number of Arab Training programs will be
(where feasible) committee that will Submit Board accredited housed by major centers
and regional proposal for pediatric fellowship programs in the region, which will
pediatric oncology fellowship to Arab in the region train fellows from the
oncology Board for accreditation ‐Number of trainees same country and
fellowship enrolled/graduated surrounding countries
programs. from such programs

5. Establishing national Forming a group of ‐Number of centers The group will utilize
policy/system for long term pediatric oncologist/others that have a long term international expertise in
care and follow up for that will prepare guidelines follow up preparing the guidelines
childhood cancer survivors. for follow up and put a program/clinic and training the
curriculum for training of ‐Number of candidate physicians.
family physicians to do long physicians trained for
term follow up of childhood the above purpose
cancer survivors ‐Completion of
regional guidelines
for long term follow
up



6. Enhancing cooperation ‐Forming national ped ‐Number of pediatric
among pediatric oncology hem/onc society in each oncology societies in
programs within each country the region
country, across the region ‐Holding a regular (monthly) ‐Number of
and with international activity for pediatric meeting/joint
centers. oncologists in each activities held
city/country annually in each
‐Having regular country and in the
teleconferences to region
exchange expertise /discuss
cases/guidelines within
each country and among
countries in the region and
with international centers

7. Establishment of national Creating regional training ‐Number of nursing These programs can
and regional training programs for nurses in training programs in cooperate and have a
programs for nurses in pediatric oncology, to be the region unified curriculum if
pediatric oncology including housed in major pediatric ‐Number of nurses possible. They also can
clinical nurse specialist and cancer centers in the graduating from such utilize international
nurse practioner programs. region. programs expertise. Such programs
can be extended to
graduate nurse
paractioners/CRNs
8. Creation of national and ‐Establish data unit in each ‐Number of data
regional registries cancer center units contributing to
/databases / research units ‐Establish a regional data a central data unit
for pediatric cancer in each center that gather data ‐Number of research
country and in the region. collected from each protocols in each
national center center and in the
region
9. Initiating prospective clinical
Disease specific working Number of trials
trials nationally and groups in the region will conducted in the
regionally in pediatric work on starting region
oncology. prospective clinical trials
after unifying treatment
guidelines and establishing
national and regional
databases
10. Including adolescents and ‐Form a group that will Number of
young adults with cancer (up submit documentation adolescent oncology
to 18‐21 yrs of age) in the related to the benefit of programs in the
age group cared for by treating adolescent patients region
pediatric oncologists as well with cancer on pediatric
as allowing young adults clinical protocols to the
with pediatric cancers to be various cancer centers’
treated by pediatric administrations and MOH in


oncologists on pediatric each country
oncology protocols. ‐Establish adolescent
oncology service in major
cancer centers in the region
11. Establishing pediatric ‐Train at least one Number of cancer Because of shortage in
palliative care programs in physician and one nurse centers in the number of oncologist,
each Arab country in each center for such region that have a the physicians could be
service. pediatric palliative family physicians,
‐Introduce the principle care program general pediatricians.
of PPC for general
pediatric departments as
well.
List centers in the region
or in Europe or North
America; where such
program is available.
12. Work with governments Each cancer center Number of countries
and drug companies to department of pharmacy facing problems with
assure continuous and pediatric oncology drug supply
availability of drugs division should submit a list
necessary to treat pediatric of medications necessary
cancer in each country. for pediatric cancer
treatment to the hospital
administration and MOH in
the country as well as to
drug companies in each
country

13. Initiating public awareness ‐Holding courses / ‐Number of such
campaign in each country workshops for primary care activities annually in
about pediatric cancer, providers in each country each country
focusing on early diagnosis by pediatric cancer centers ‐Number of cases
and importance of seeking to educate them about referred in early
care at specialized centers pediatric cancer. stage
nationally and regionally. ‐Holding public awareness
campaign regularly by
major cancer centers/ped
oncology societies in each
country utilizing various
media outlets

14. Mandate the presence of Each pediatric oncology Number of programs
quality assurance measures program to have regular having such activity
in each center such as tumor board, M& M in the region
Mortality & Morbidity meetings
meetings, Multi‐disciplinary
clinics and tumor boards.


Objective Action Step Indicator Comment

15. Establishing patient ‐Approaching charities and ‐Number of Such
support groups in each businesses in each country charitable groups/organizations
country that are focused on to establish such organizations should have active
pediatric cancer. organization focused on pediatric websites to educate and
‐Encouraging parents of cancer in the region support families
children with cancer in each ‐Number of
country to form a parents’ family/parents
support group support groups in the
region

16. Establishing several cord To define countries in the Number of cord
blood banks in the region region that can establish / blood banks in the
and national and regional have regional cord blood region
unrelated marrow donor banks
registries.

17. Enhancing multi‐ ‐Organizing training ‐Number of courses
disciplinary care for pediatric programs / courses for conducted
oncology patients other subspecialists and ‐Number of ped onc
members of ancillary programs having
services in pediatric tumor boards/MDC
oncology
‐Starting tumor board and
multi‐disciplinary clinics in
each pediatric cancer center

18. Working with government Forming a group of Number of countries
agencies in each country to pediatric oncologists in each having such strategy
put a national strategy for country that will write a
pediatric cancer care proposal that details care
strategies, funding,
research, technology,
education and continuous
professional development
and submit it to authorities
in each country

19. Activation of present Pediatric oncologists in each Number of countries Countries already having
national pediatric oncology country should form a having such society society should improve
societies and establishing society that should have a their standard to cover
ones in countries where this clear vision, have elected all aspects mentioned
is lacking. executive committee and
secured funding. Such
society should have various
activities related to
improving patient care,
treatment standards,
research, and
education.etc.


20. Encouraging new ‐Joining regional Disease Number of new
pediatric oncology working groups and programs twinned
programs in the region to network with larger centers
twin with a more well ‐participating in
established regional teleconferences with
program and to consult international centers
regularly with an
international renowned
pediatric oncology center
or with a regional network
21. Establishing a regional ‐Interested representatives ‐Number of countries
network / organization for participating in ICCAW can represented in the
pediatric oncology be the starting members network
‐Members from other ‐Number of disease
countries can join the specific working
network later groups formed
‐ ‐Network will form disease
specific working groups and
follow/ facilitate their work
‐the network members
should have regular
teleconferences and at least
one annual
business/scientific meeting
‐The network will facilitate
the establishment of
national and regional
pediatric cancer databases
‐The network will help in
establishing pediatric
oncology training programs
for physicians and nurses in
the region

STRATEGIC OBJECTIVE FOR 2020
Reduce morbidity and mortality of pediatric cancer patients in the Arab World.

Action Steps:
vi. Form a regional network that will facilitate the development of pediatric
cancer care programs in all Arab countries.
vii. Develop a proposal for pediatric hematology/oncology physician
fellowships and submit to the Arab Board/Local Boards for accreditation.
viii. Establish Regional Training Programs for pediatric hematology/oncology
nurses, including advanced nurse practitioners, and for other pediatric
oncology specialist supportive care providers such as dietitians, patient
educators, and clinical pharmacists, social workers and psychologist.
ix. Establish a pediatric palliative care program in each Arab country.
x. Create national and regional databases for pediatric cancer.

SHORT TERM 12 MONTH OBJECTIVE

Establishing a Regional Network of pediatric oncologists.

Action Steps:
• Interested representatives participated in the Initiatives to improve cancer care in
Arab
countries (ICCAW) will be the starting members.
• New interested members can join the network later.
• The network members will have regular Teleconferences to discuss various issues in
the
following areas: Patients care, Training and education and Research opportunities.

FOLLOW‐UP PLAN
The panel plans to sustain its momentum and continue its work in the future. At
least one follow up meeting is planned in the next 1 year. The meeting may be
independent meeting or adjunct to other conference or activity. Continued
communication by e‐mails is crucial to update members, exchange ideas and
information about related activities and news.

l. Annual Update will be done in a special session at the Annual AMAAC meetings
or other regional meeting that the members choose where relevant projects and
updates from the panels will be presented.

CONCLUSIONS
Pediatric cancer care faces many challenges in the Arab World in spite of
recent developments in this field across the region. This report includes certain
recommendation that may help interested parties to improve the situation of
pediatric cancer care in the region.

REFERENCES
1. www.uicc.org/declaration


AVAILABLE RESOURCES

Affiliation
Type Governmental, Location / Contact Specific areas of
Entity Name Individual, Non‐Gov. Address Information expertise and
Company Private Phone, Fax, Email interest
Org.,University Website
Association EL AMEL Organization Non‐ gov. Algiers Help patients &

PLACE du 1er +213 661443722 families
mai Screening of cancer
Pierre & marie curie Algiers Diagnosis,
center Hospital Govt. Rue batandier +213 21235096 treatment &
research
World Health Organization United Nations Regional Regional Director:
Organization Office, Dr. Hussein Gezairy
Cairo, Egypt

International
Network for Cancer Organization Non‐Gov. Brussels, President:
Treatment & Belgium Dr. Ian Magrath
Research

International Union Geneva, CED:
Against Cancer (UICC) Organization Non‐Gov. Switzerland Cory Adams

National cancer University of Government Wad Madani – Fax:
institute Gezira Sudan 002495118466640

Ministry of Health Governmental Gov. Post Box 5, www.moh.gov.kw
Sulaibikhat,
Postal Code:
13001

King Fahd Specialist Cancer Center.
Hospital Dammam Institution Gov. Dammam 03/8431111 Organ
www.kfshd.med.sa Transplant.Neuro‐
Science

Children’s Cancer Free standing Non gov. 1 Sadem El Kat Sherif Abouelnaga All issues
Hospital Egypt 57357 children’s cancer Street M.D. pertaining to
hospital Sayeda Zeinab, VP Academic pediatric cancer
Cairo ,Egypt Affairs, Research nationally,
and Outreach regionally and
011 2010 2149920, internationally.
snaga@57357.com
www.57357.com


Entity Name Type Affiliation Location / Contact Specific areas of
Individual, Governmental, Address Information expertise and
Company Non‐Gov. Phone, Fax, Email interest
Org.,University Private Website
MECCA Non‐profit QNRF (Qatar Hamad Medical +974‐439‐5035, Research,
organisation National Corporation, 5036, 5037 Education and
(multi‐center) Research Hamad Medical Fax: +974‐ improving outcome
Fund), City, building# e‐mail: and quality of life
Qatar 16, 2nd floor, naima.almulla@gm
Government,(H Doha ‐ Qatar ail.com
amad Medical
Corporation) or MECCA web site:
(King Faisal http://rc.kfshrc.ed
Specialist u.sa/MECCA
Hospital and
Research
Centre)‐
Riyadh, KSA

Heidelberg University University and Germany Children's
Hospital Hospital Hospital Tel: 06221 564555
Im Fax: 06221 564559 Service, research in
Neuenheimer e‐mail Hematology and
Feld 150 andreas.kulozik@m oncology
D‐69120 ed.uni‐
Heidelberg heidelberg.de
Germany www.kinderonkolo
Tel gie.uni‐hd.de
+ 49 6221 56 Andreas E. Kulozik,
2303 MD, PhD
Secretary Professor of
+ 49 6221 56 Pediatrics
4555 Department of
Fax Pediatric Oncology,
+ 49 6221 56 Hematology and
4559 Immunology

Hospital for Sick Kids, Hamad Medical Gov. of Qatar New Children Abdulla Al‐kaabi, All pediatric
Toronto, Canada in Corporation Hospital in MD subspecialties,
Qatar (HMC) ‐ Qatar Hamad Medical Hamad Medical education and
City Corporation research
Pediatrics
Aalkaabi1@hmc.or
g.qa
P.O.Box: 3050
Tel.: +974‐439‐
2834
Fax: +974‐4439571


Affiliation
Type Governmental, Location / Contact Specific areas of
Entity Name Individual, Non‐Gov. Address Information expertise and
Company Private Phone, Fax, Email interest
Org.,University Website
Children’s Hospital 300 Longwood Kathy Houlahan Pediatric Oncology
Boston Hospital Private Ave Kathleen.houlahan Leadership
Boston, MA @childrens.harvard Staff Education
02115 .edu EBP
Dana‐Farber Cancer Hospital Private 44 Binney St Kathy Houlahan Same
Institute Boston, Ma Kathleen.houlahan
02 115 @childrens.harvard
.edu
King Faisal Specialist +974‐439‐5035,
Hospital Hospital Gov. Riyadh, Saudi 5036, 5037 Training,
Arabia Consultation
MECCA web site:
http://rc.kfshrc.ed
u.sa/MECCA
King Hussein Cancer Hospital Gov. Amman‐Jordan +962‐6‐5300460
Center Dr. Mahmoud Training,
Sarhan Consultation
msarhan@khcc.jo
St Jude Children’s Hospital Non‐for Profit Memphis, TN www.cure4kids.org
Research hospital, USA www.stjude.org
Dr. Ibrahim
Qaddoumi
Ibrahim.qaddoumi
@stjude.org
National Guard Organization Gov. Riyadh, Saudi www.ngha.med.sa
Health Affairs Arabia Dr. Reem Sudairy
sudairyr@ngha.me
d.sa
Dr. Mohammad
Jarrar
jarrarm@ngha.med
.sa
King Abdullah Organization Gov. Riyadh, Saudi www.kaimrc.med.s
International Medical Arabia a Research Funding
Research Center
Dr. Mohammad Al‐
Jumah
jumahm@ngha.me
d.sa
SANAD Organization Non‐for Profit‐ Riyadh, Saudi Research
Charity Arabia funding/patient &
family support


Funding Cancer Care Inaugural Meeting Report
Funding Cancer Care

Funding Cancer Care
Dr. Sherif Abou El Naga and Dr. Falah Al Khatib
*on behalf of the Funding Cancer Care Panel Members

PANEL OBJECTIVES
Discuss role of government and non‐government agencies (NGOs).
Discuss the role of pharmaceutical companies.
Present recommendations on fund raising for cancer care.

PANEL MEMBERS

Facilitator
Dr. Falah al Khatib Chief of Radiotherapy Dept. Tawam Hospital, Abu Dhabi, UAE
Gulf International Cancer
Center
Dr. Sherif Abouelnaga Vice President Academic Affairs, Children’s Cancer Hospital Cairo, Egypt
Research and Outreach. Egypt 57357
Deputy Director, CCHE 57357

Name Institution Country
Dr. Mahmoud Shaheen King Abdulaziz University Hosp Saudi Arabia
Dr. Yaser Abdulrazak Advanced Medical Care Center Syria
Dr. Khaled Al Jamaan KAMC ‐ Riyadh Saudi Arabia
Dr. Ahmad Al Mazroie Lusail Qatar
Dr. Mohamed El Sayes Saudi Cancer Foundation Saudi Arabia
Dr. Abdulrahim Gari Gari Medical Center Saudi Arabia
Dr. Basim Al Bahrani Sultan Qabous Hospital Oman
Dr. Lamya Alzubaidi University of Sharjah UAE
Dr. Ali Khawlani National Cancer Control Foundation Saudi Arabia
Dr. Sawsan Al Madhi Friends of Cancer Patients Society UAE
Jazzylyn Rodriguez rodriguezja@ngha.med.sa +96612520088 Ext 14107 / Fax: +96612520088 Ext 14691
Panel Guest
Name Organization
Mr. Abdulwasa Hayel Saeed National Cancer Control Foundation
Dr. Ghassan Abou‐Alfa Memorial Sloan‐Kettering Cancer Center
Dr. Reem Al Sudairy KAMC ‐ Riyadh
Nabila Al‐Ghonably SANAD
Manal Zaidan Hamad Medical Corporation
Name Organization
Ibrahim Qaddoumi St. Jude
Ali Al‐Shanqeeti King Fahad Medical City
Mohammad Jarrar KAMC ‐ Riyadh
Kathy Houlahan Boston Children's Dana Ferber Cancer Inst.
Name Organization
Leslie Lehman Boston Children's Dana Ferber Cancer Inst.
Khulood Al‐Saad SMC
Maina Al‐Mulla Hamad Medical Corporation
Oumaya Fawaz Basma
Raul Riveiro St. Jude
Dr. Kamal Abdel Rahman Ali
Barri Blauvelt CEO, Innovara Inc.
Nagham Sheblaq KAMC ‐ Riyadh
Nada hamdi KAMC ‐ Riyadh
Daniela Mengato EASO
Roberta Ventura EASO

ABSTRACT

Background:

The purpose of the Funding Cancer Care ICCAW Working Group was to discuss the
issues surrounding funding of cancer care throughout the Arab world particularly in
the areas of the role of governmental and non governmental agencies, the role of
pharmaceutical companies in supporting cancer care, looking at perceived needs of
the individual countries and then present recommendations on fundraising for
cancer care for all Arab countries.
Methodology:
As one of the workshops of the strategic conference, ”Initiative to Improve Cancer Care in
the Arab World” the methodology that was employed for all workshops was utilized for
the “Funding cancer care workshop.” Twelve panel members who represented all
Arab countries and different oncology disciplines, were asked to compile a document
outlining their country’s needs, good projects, and resources prior to the conference.
The panel then looked at these and developed a set of objectives that they hope to
complete in 12 months. Twenty guest panelists from internationally recognized
centres such as St. Jude Children’s Research Hospital and Memorial Sloan Kettering
participated in the workshop providing their expertise.
Results:
Recognizing the wide financial disparity between ‘too much’ and “not enough” Arab
countries, it was agreed that the more affluent countries need to help the others
through fundraising training, assisting in capacity building, and providing mentorship
to achieve better access for all. The affluent countries would collaborate in what
was defined as a “peer jealousy” strategy working in healthy competition to
capitalize on each other’s strengths and achieve the goal of financially secure
comprehensive cancer care programs for all. To begin, it was agreed that a chapter
of fundraising professionals would be established and that the process of training
would begin.

Conclusion:

Fundraising is both an art and a science and to achieve best results in fundraising
campaigns, it is necessary to understand process, strategic marketing and
implementation. To begin to meet the varied and complex needs of cancer patients
throughout such a financially diverse region, the best approach is to develop
fundraising expertise prior to fundraising for program development and
sustainability. An identified group of countries would act as mentors and experts to
help those countries who were lacking in fundraising expertise and a fundraising
strategy would be developed.

INTRODUCTION

The incidence of cancer is increasing worldwide and consequently the economic
costs associated with its management. By 2030, it is estimated that there will be 27
million incident cases, 17 million cancer deaths annually and 75 million persons alive
with cancer. [1] The greatest effect of this increase will fall on low‐resource and
medium‐resource countries such as the majority of the Arab countries. A major
challenge for economically emerging countries is to find strategies to properly utilize
their limited resources in managing cancer or it could become a major obstacle to
their socioeconomic development. [2]

In a report by the NCI, USA,[3] an estimated $72.1 billion in 2004 was spent on cancer
treatment which was just under 5 percent of U.S. spending for all medical treatment.
Between 1995 and 2004, the overall costs of treating cancer increased by 75
percent. Below is a table with the amount of money spent from 1963‐2004.

Cancer spending in this chart does not include screening, which cost an additional
$10 to $15 billion in 2004. Direct medical expenditures are not the only component
of cancer costs. Indirect costs include losses in economic productivity resulting from
cancer‐related illness and death. The total economic burden of cancer in 2004 is
estimated to have been $190 billion in the US alone. There is no accurate data in the
Arab countries to assess costs but it is certain that their governments cannot
adequately meet the economic burden in most of these countries.
While a number of Arab countries reported free healthcare for cancer patients,
many of them offer partial or no coverage and some of them do not offer service for
expatriates. Many countries lack adequate equipment, medications, supplies and
lack of trained staff. People who have vast financial resources often travel to
European or North American centres to receive their medical care but at significant
costs: a bone marrow transplantation can cost 300,000 to 1 million USD depending
on type and if there are significant problems. Some of the new biologic response
modifiers or mono‐clonal antibody medications being used for lung cancer, colon
cancer, leukemia have significant cost associated with them ranging from 3000‐
50,000 USD or more per treatment. There is also significant cost for supportive care
medications such as white cell and platelet stimulating medications, latest
generation antibiotics and anti‐fungals, anti‐emetics, and complex surgical
procedures such as limb salvage microsurgery, neurosurgery utilizing intra‐operative
MRI, brachytherapy for eye tumours, etc. Some patients’ treatments have ended
costing millions if the family has been able to afford it. However, the emotional cost
is often higher: being separated from their family support system in a country of a
different culture, value system and language. There is limited opportunity to travel
within Arab countries to obtain state of the art treatment because of lack of
availability of these treatments and with most countries unwilling to treat
expatriates fearing lack of financial compensation. People who are of moderate
incomes often receive their care in private hospitals within their own countries but
may not have access to the latest cancer treatments because of lack of availability of
the advanced medications or procedures.
Essentially the Arab countries range from extremely limited resources and
healthcare services to countries with large budgets and advanced health care. What
is the solution then to improve cancer care throughout the region?
One of the biggest financial demands on people world‐wide is the high cost of health
care. Many families are one illness or accident away from financial ruin. Often
private health insurance costs reduce workers’ take‐home pay to a degree that is
unnecessarily high thus encouraging people not to participate in such plans. At the
same time, health care costs are consuming a growing share of government budgets
both on national and local levels if there is split funding. The United States alone,
spends over $2.2 trillion on health care each year—almost $8,000 per person. That
number represents approximately 16 percent of the total economy and is growing
rapidly and it is estimated that by 2017, almost 20 percent of the economy—more
than $4 trillion—will be spent on health care. [4] In 1960, the cost of health care in
the Organization for Economic Cooperation and Development [OECD] countries
consumed just under 4% of their collective GDP. By 2000, it consumed twice as high
a share of the GDP and has continued to rise. [5]
However while most countries are attempting to contain cost, they must meet the
needs of the majority of their people who are lacking healthcare coverage. An
unhealthy workforce leads to an unhealthy economy, and working towards providing
people with low cost access to healthcare and cancer care is not only a moral
imperative, but it is also essential to a more effective and efficient health care
system. [4]
There are generally five primary methods of funding health care systems: [6]
1. general taxation to the state, county or municipality,
2. social health insurance,
3. voluntary or private health insurance, and
4. direct or out‐of‐pocket payments of the individual person
5. donations, non governmental organizations, corporate social responsibility or
community health insurance [7,8].
Most countries' systems feature a mix of all five models. One study [5]based on data
from the OECD concluded that all types of health care financing "are compatible
with" an efficient health care system. The study also found no relationship between
financing and cost control.
The 5th method: “donations, non governmental organizations, corporate social
responsibility or community health insurance” plays a large role in supporting
healthcare both from the healthcare system perspective but also from the citizen’s
perspective who is in need of financial support for emergent healthcare needs. It is
estimated that as much as 25% of healthcare costs are covered by donations in
North America. [9] In North America, healthcare charity funds are a significant
component of program support and expansion, equipment and facility upgrade,
research and for assisting individuals in receiving specialized treatments in other
locations as well as out of pocket costs such as transportation, accommodation,
living expenses for needy families. Studies have also shown that socio economic
status is directly related to successful outcome and access to treatment. [10,11,12, 13,14]
The two most consistently successful fundraising efforts in the United States are the
St. Jude Children’s Research Hospital which was established and is sustained by
fundraising only and has a highly organized national fundraising team raising in the
area of 750 million USD annually[15] and the annual Jerry Lewis Telethon for Muscular
Dystrophy which has raised more than 1.46 billion USD since its inception in 1966.[16]
Both of these are non‐profit organizations and have contributed substantially to the
improvement of the lives of children.
Recognizing that governments are unable to bear the burden solely for healthcare,
more of the public are coming to realize that multi‐sector partnership is imperative
to achieve healthcare systems that are able to provide the best outcomes. Nowhere
is this more important than cancer care and the proof is in the WHO world statistics
which show that 60‐65% of adults are cured of cancer in developed countries and
80‐85% of children with cancer are cured but they represent only a small percentage
of the total world incidence. Whereas, in developing countries, these statistics are
significantly different: approximately 30‐40% of adults and children are cured.[1]
Multi‐sector partnership is the triad of government, business and the public which is
integral to obtaining more comprehensive and equitable healthcare for all.
In the Arab countries as a whole, non‐governmental organizations, individuals, and
the business community contribute sizeable amounts of money for cancer care:
• building new cancer hospitals [CCHE 57357, Sudan 99199, Syria, etc.],
renovating existing cancer facilities
• program expansion such as breast screening and early detection,
microsurgery for bone cancers, eye tumours, neuro‐oncology surgery, blood
bank, clinical pharmacy
• equipment upgrade such as radiotherapy machines, cytogenetics testing,
MRI, CT scans
• medications and supplies such as: chemotherapy, antibiotics, syringes,
intravenous fluids
• education and specialization training assistance for junior physicians,
pharmacists, and nursing.
The role of pharmaceutical and medical equipment companies in fundraising in
cancer care and healthcare in general has been discussed frequently because of
potential issues of conflict of interest. A paper by Sharon Batt, for Women and
Health Protection, January 2005, “Marching to Different Drummers: Health Advocacy
Groups in Canada and Funding from the Pharmaceutical Industry” states:
“Studies of actual physician behaviour on biased behaviour showed that house staff
who attended grand rounds given by a pharmaceutical company speaker were more
likely than their colleagues to prescribe that company’s drug as treatment, even
though they did not remember what company sponsored the grand rounds. A study
of medical residents found that 61% believed promotions did not influence their own
practice, yet only 16% believed that other physicians were
impervious to influence from promotional gifts. Another study found that 19 out of
20
physicians who attended medical education seminars sponsored by two drug
companies
denied the seminars would influence their behaviour before attending. In fact, use of
the
companies’ drugs did increase after the seminars. Research with physicians has
found
that bias is strong, even with small stakes. Based on their review of psychological and
physician practice literature, these authors conclude that attempts to control bias by
limiting gift size, by educational initiatives, and by mandatory disclosure are likely to
fail
because they rest on a faulty model of human behaviour. They conclude that the
implication for industry gifts to physicians is straightforward: they should be
prohibited.”

However in countries with limited resources, physicians have come to rely on
pharmaceutical companies and medical supply companies for assistance in
continued professional development, medication, equipment, and supply donations
to help their programs function. It is recommended that a policy should be
developed to address this issue to take opportunity of the corporate social
responsibility but at the same time eliminate the risk of conflict of interest for
themselves and their institutions.

Finally, as previously mentioned, the disparity is wide and there is little in the way of
organized efforts of the ‘too much countries” extending their assistance; financial or
expertise, to the “not enough” countries. The ICCAW meeting has begun to address
this and to look at ways of how to help each other and unify their efforts for the
good of cancer patients throughout all Arab countries. The panel examined the
different issues, needs and the possible solutions to funding cancer care in the Arab
countries and developed a comprehensive strategy to be applied over the next year.

The ICCAW was initiated to “develop strategic recommendations to improve cancer
care in the Arab countries.” The meeting was hosted by the National Guard Health
Affairs jointly with Arab Medical Association Against Cancer in collaboration with
National and International organizations and entities such as WHO.
In preparation for the meeting; several working groups/ panels were assembled to

do the ground work and preparation for the launch of the initiative. Thirteen panels
were formed that addressed different topics relevant to cancer care. Each panel
member was assigned to complete a form regarding positive projects and actions in
their country, weaknesses, recommendations, and resources they knew about in
their countries or externally.
The working groups consisted of facilitators and members from various Arab
countries based on interest, expertise and nominations as well as international
experts. The objective of the working groups was to:
a. Present the situational analysis on the specific issue.
b. Presentation of relevant experience of the Arab Countries.
c. List and prioritize the panel strategic and specific recommendations. Keep
personalized medicine in focus.
d. Recommend specific action steps. Specify measureable objectives and
timelines especially what should be achieved in the next 1‐2 years (i.e. next
practical steps)
e. List references and available resources that could be utilized in the area of
interest.
f. Generate a document outlining process and strategies.

The funding cancer panel objectives were:
• Discuss role of government and non‐government agencies (NGOs)
• Discuss the role of pharmaceutical companies
• Present recommendations on fundraising for cancer care

The meeting held from March 23‐25 in Riyadh then began looking at the
completed documents in their individual groups and formulated strategic
objectives based on the discussions and brain storming. In the fundraising panel,
many needs were identified by all countries; but the process of achieving these
needs was not clear. It became evident that what was lacking in most countries
and oncology centres was expertise in fundraising and promoting their projects
to the public to generate the necessary funds. Fundraising training became the
immediate priority.

All countries who participated were able to list accomplishments in cancer care
programs, as well as the perceived needs of their country.

Strengths of individual centres and countries

1. Saudi Arabia
a) Mobile Mammography Truck is an on‐going success story in the field of early
detection
of breast cancer. There are two trucks until now and Saudi Cancer
Foundation has the
honor of owning the second one to be the first charity organization who
managed to
provide this service with a non‐government donation.
b) Early Detection Centers (e.g. Abdullatif Al‐Abdullatif Early Detection Center
in Riyadh is another example of success to the relevant topic. Saudi Cancer
Foundation has started the process of building a similar center in Eastern
Province.
c) Cancer patients are getting services from designated foundations and
societies in a way that can’t be provided by government using non‐
government donations.
d) Getting the pharmaceutical companies to involve more in supporting the
awareness campaign in different cancer types resulted with a continuous
outreach programs that has been repeated several times every year in all
Kingdom sectors.
e) Availability of high level tertiary centers.
f) Compulsory Insurance for Expatriates not eligible for treatment at Tertiary
Centers.
g) Strong charity funding
h) Highly trained health professionals
i) Availability of high cost drugs at least at tertiary centers
j) Good Oncology Centers for treating oncology patients across the country
k) The treatment of oncology patients is provided by the government for free
l) Well trained staff (physicians, nurses)
m) Saudi Oncology Society
n) Tumor registry

2. Syria
a) Free governmental cancer treatment access.
b) Tumor registry
c) Fair number of worldwide Hem‐Onc highly‐specialized physicians of Syrian
nationality
d) Moderate improvement in cancer awareness
e) Strong charitable organizations supporting cancer care and chronic
illnesses in general

3. Egypt
a) Children’s Cancer Hospital Egypt 57357, a 187 bed state of the art hospital,
was built completely by donations and is being sustained by donations
through an NGO, the Association of friends of the National Cancer Institute
and operated by an NGO, the Children’s Cancer Hospital Egypt 57357
Foundation. Largest children’s cancer hospital in the world providing free
care to children regardless of race, creed or ability to pay. A true example
of multi‐sector partnership. i.e. public, private, corporate. Has many
creative fundraising programs such as , sponsor a bed, sponsor a child,
naming opportunity, employee donation program, estate program.
Learning organization: has had over 150 physician, scientists, nursing,
health management experts give presentations or workshops to staff and
external professionals regarding clinical, research and quality of care issues
surrounding cancer patients. Patient education is a priority and several
materials are being developed. Had the first anti‐smoking commercials
targeting children and second hand smoke
b) Association of Friends of the National Cancer Institute: founded in 1997,
has raised more than 2 billion LE for the needs of cancer patients such as
the children’s cancer hospital, equipment and services upgrading for the
National Cancer Institute, educational programs for staff.
Established the first voluntary blood donor program in Egypt to support
the NCI blood requirements and since 1999 has collected more than
180,000 units of blood.
Creative fundraising through 0900 numbers, internet numbers, mobile
numbers.
Cancer health education: published the first cancer handbook for children,
Cancer
Facts for Kids.
c) Breast Cancer Foundation of Egypt has developed breast cancer awareness,
a prosthetic program, and mammography screening.
d) There are hundreds of NGO’s working in many aspects of cancer care
support throughout Egypt to help individual patients, programs on a small
scale.
e) Friends of Children with Cancer raises money for medications for small
centres
throughout Egypt that treat children. They are also building a
camp/retreat for
children suffering from cancer and their families.
f) The government has instituted a national breast cancer screening program
with a
mobile mammography unit going to outlying regions
g) Educational upgrading: a pediatric oncology fellowship program is being
developed
jointly with Cairo University, National Cancer Institute and the Children’s
Cancer
Hospital Egypt 57357 to increase skill level to international standards and
to
increase the number.
Continuing professional development: Egypt has many societies
specializing in oncology who have regular conferences.
There are several initiatives through the Egyptian universities that are
connected with grant programs such as the European union, USAID that
work in specialist and general skills upgrading for physicians, nurses,
pharmacists.
Pharmaceutical companies have taken an active role in sponsoring
educational programs for individuals and groups.
h) The Egyptian government recognizing the disparity of care for cancer
patients in the late ‘90’s established 10 outlying cancer centres
throughout the country to meet the demand. These centres serve adults
and children and have diagnostic capabilities as well as providing access
to treatment: surgery, chemotherapy, radiation therapy.
These centres are also supported by local NGO’s for equipment
upgrading and patient support.
i) The government has begun anti‐smoking campaigns and other health
awareness
campaigns over television, radio and newspaper.

Weaknesses

1. Saudi Arabia
a) Treatment of non‐Saudi citizens has been a huge issue for local cancer
foundations.
There are people who lived in Saudi for their entire life yet they can’t be
accepted for
cancer treatment in government hospitals.
b) A National Council for Cancer Care is needed to organize all efforts and
provide
proper coordination channels between all cancer care organizations and
treatment
centers. This council will organize all funds for cancer care.
c) Lack of cooperation between car providers
d) Lack of access for expatriates to tertiary centers
e) Weak regional centers
f) Lack of proper standardizations of treatment among the centers
g) The oncology centers are located in the large cities
h) Shortage of radiation oncologist

2. Syria
a) Centralization of the cancer care: Basically in the capital and large cities
only
b) Poorly functioning tumor registry
c) Lack of medical, nursing and other health allied staff with poor training
d) Failure of the governmental free care: budget‐dependent, regulations,
inadequacy, traveling difficulties and expenses
e) Deficiency in radiation centers
f) Lack of standardization of the cancer care
g) Poorly controlled private sector: very high cost, poor nursing

3. UAE
a) Absence of an organization providing structure or function for cancer care
planning, development, implementation, monitoring and periodic
evaluation.
(National Cancer Committee).
b) Lack of Unique National Number.
c) Lack of electronic data transfer between centers.
d) Fragmentation and duplication of services.
e) Lack of coordination and cooperation between centers dealing with cancer.
f) Shortage of manpower at all levels (doctors, nurses, technicians, etc).
g) Lack of space both for out patient and in patient facilities.
h) Old equipment requiring replacement or major upgrade.
i) Interrupted and in general, inadequate supplies, which include
pharmaceuticals.
j) Absence of sub specializations.
k) Inadequate and fragmented lab facilities (electron microscope, PCR, Storage
and tissue freezing.)
l) Lack of some specific therapeutic facilities such as Stem Cell Transplant.
m) Lack of hospital and national protocols for the treatment of major cancers.
n) Inadequate palliative care/terminal care and rehabilitation facilities.
o) Absence of organized national screening programs.
p) Absence of cancer prevention programs.
q) Inadequate strategy for recruitment and retention of qualified staff.
r) Absence of support for professional development.
s) Lack of continuity and absence of incentives.
t) Inadequate charitable support for non national patient.
u) Inadequate programs for awareness and education for health provider and
for the public.
v) Absence of a workable policy to deal with costs for expensive treatment for
non‐nationals by implementation of a Health Insurance plan.
w) Failure of existing strategy of sending patients abroad to provide an
acceptable standard of care.
x) Inadequate and fragmented tumour registry.

4. Egypt
a) Although there are many NGO’s working for cancer patients, they work in
islands often in the same hospital and don’t work to combine their efforts
for a better utilization of funds.
b) Poor vision and lack of strategic planning on all levels for cancer care results
in fragmentation of care and resources.
c) Lack of trust at the corporate and community level as to how donations are
utilized.
d) No idea of true numbers of cancer patients in Egypt as the cancer registry
captures only certain centres so therefore cannot determine financial
burden or needs in regards to facility planning, staff requirements.
e) Although educational programs exist, it is limited, most hospitals do not
have continuing education programs for all staff : ie. Physicians, nurses,
pharmacists, and other support staff. Therefore quality of care is poor.
f) Very little being done in cancer prevention and public cancer education
programs and it is difficult to get funding from even private sources. Some
of this is due also to the
logistics of making the material accessible to 78 million people. For
example, there over 35,000 schools serving a population of 35 million
school age children and not including the several hundred universities and
colleges. How to disseminate the information to such large numbers?

RECOMMENDATION
After intense discussion, it became clear that the most urgent priority was for people
to gain fundraising expertise in order to achieve their goals of better cancer care. As
mentioned elsewhere, fundraising is both an art and a science, and training is
needed to understand the methodology of developing a visionary fundraising
strategy, acquiring targeted goals, competing with other causes on the market,
developing a competent team who can achieve sustainable results and building a
group of loyal, donors who are committed for the long term. Below is the table of
objectives that the different panelists had developed with the fundraising as priority.
TABLE 1. RECOMMENDATIONS


*To develop 1. Develop a regional chapter of 1. There will be at least one
fundraising expertise association of fundraising representative from each
through fundraising professionals. country who will have received
training programs. 2. Conduct regional fundraising training the fundraising course and who
will be able to develop a plan
for his centre.
*To develop countries 3. develop the vision and strategy as a 2. The completion of the white
wide strategy for whole for funding before getting into paper
funding for cancer in details 2. Implementation of white paper
Arab countries 4. Identifying funding needs
5. Identify funding sources and
methodology for above needs and
strategies
6. Develop guidelines or action steps for
funding
7. Develop a white paper that will
summarize and come up with a plan of
action.
*To identify shortfalls 1. Gather governmental data regarding 1. The identification of funding
in funding for cancer cancer costs, financing. shortfalls once data is collected
on a local and regional 2. Gather data as to non governmental and analyzed.
scale sources of funding and percentage of
total for all countries.
3. Analyze data to discover shortfalls.

*To promote multi‐ 1. Develop plan for promoting multi‐ 1. Completion of the plan for
sector cooperation in sector cooperation I.e. promoting multi‐sector
funding for cancer on 2. Awareness campaign cooperation for funding.
local and regional 3. Message of campaign 2. Implementation of steps on a
levels. 4. Who to contact regional level.
5. How to contact
6. What is needed

*To identify regional 1. Gather information about all needs 1. Completion of plan
cancer issues for and identify most pressing from 2. Implementation of plan.
immediate funding government, healthcare professionals,
and user perspectives.
2. Develop action plan for achieving
funding and resolving the issue.

*To identify and 1. Issue a Dhs 1 anticancer stamp to be 1. In place 1. Government
develop fundraising added to all mail. legislation
campaigns 2. Issue a DHS 10 official stamp to be
added to all government applications,
documentations, contracts, etc.
3. Access to Zakat money.
4. Red Crescent Organization.
5. 20% on cigarette packs of rice.
6. 2 Fils on each liter of gasoline and
other petrol products.


Detecting early cancer 1. Fund raising campaign to reach a 1. Purchasing the targeted trucks
stages as many as target of 3 Mobile Mammography and making it operational.
possible Trucks for every province. 2. Build centers and making them
2. Fund raising campaign to reach a operational.
target of at least one early detection
center in every province.
3. The above campaigns will include
public awareness about the
importance of early detection.
Every cancer patients 1. Try to increase the number of cancer 1. Increasing the number of
should be treated as treatment centers within the Kingdom. Cancer Treatment Center by at
soon as possible. 2. Encourage more junior Saudi doctors least 2 centers in every
to specialize in Oncology field. province that shows high
3. Encourage more Saudi nurses to incidences of cancer.
specialize in Oncology field. 2. 50% of Oncology doctors in
every center should be Saudis.
3. 50% of Oncology nurses in
every center should be Saudis.
Advancing non‐profit 1. Directing the NGOs to take a major 1. Number of NGO based cancer 1. Collaboration
healthcare (NPHC) role in cancer care through more centers – rather than
organized NPHC practice. 2. Number of cancer patient competition –
2. Enhancing NPHC performance: assistance programs (Al Afia needs to be
governance, community benefit, Funds‐Basma for Cancer extended to
relationships among PNHC Among Children) patient care
organizations. benefit calling
3. Focusing on the important for:
collaborations among NPHC and other National
stakeholders (government‐ Alliance for
government support NGO‐private Advancing
sector) on high quality cancer care. Cancer Care
Standardization of the 1. Promoting established guidelines 1. Number of malpractice cases
cancer care 2. Promoting Evidence‐Based Practice 2. Monitoring the morbidity and
3. Setting hospital‐based cancer registry mortality incidence
reporting standers and monitoring the
adherence to these standards

Human resources 1. Increase medical residency and 1. Number of medical residency
development fellowships in Hem‐Onc and Radiation programs and nursing,
Therapy radiation therapy, nuclear,
2. Promoting Continuous Medical physicists programs.
Education, conferences and research 2. Number of graduates
activities 3. CME credits conducted per year
3. Establishing specialized nursing 4. Number of conferences and
training after the available basic distance learning activities
academic training.
4. Establishing academic programs in
radiation technology, Nuclear
Medicine, medical physics.
5. Communicating with the specialized
physicians and other health alliance
staff working abroad to support the
cancer care in the country (probably
through outsourcing programs)


Improve the cancer 1. Population‐based cancer registry and 1. Number of malpractice cases
registry and using establishing cancer data mapping 2. The availability of Surveillance
information 2. Hospital Cancer Registry Cancer and Epidemiology Results for
technology to improve Reporting Standards better cancer care and
quality and reduce 3. Reporting a quality management prevention
costs concept
Improve the cancer 1. Population‐based cancer registry and 1. Number of malpractice cases
registry and using establishing cancer data mapping 2. The availability of Surveillance
information 2. Hospital Cancer Registry Cancer and Epidemiology Results for
technology to improve Reporting Standards better cancer care and
quality and reduce 3. Reporting a quality management prevention
costs concept
1. Define cities where oncology care 1. Production of report
Ensure Regional should be established
Oncology Care 2. Survey current situation of regional 2. Production of report
oncology care 3. Number of proposals; Reach
3. Explore feasibility of cooperation of agreement
between care providers (eg. MOH,
MODA, NGHA, KFSH, SFH, Private) 4. Production of terms of
4. Creation of Cancer Center Council reference
1. Improve Insurance Coverage 1. Reaching positive difference
Ensure Oncology Care in 2 survey of Insurance
for Expatriates 2. Upgrade facilities in the Private Companies
Sector 2. Number of agreement
3. Improve Charity Funding between Private Centers and
Tertiary Hospitals
3. Percentage of increase in
Charity Funding
1. Performing Survey at start 1. Production of Survey Results
Improve Patient 2. Establishing Recommendations for 2. Production of
Satisfaction at Cancer survey at start Recommendation
Centers 3. Putting implementation Plan of 3. Assessment of % of
Recommendations Implementation
4. Performing 2nd survey 12 months later
5. Establishing Recommendation for 2nd 4. Production of 2nd Survey
Survey Results
6. Putting implementation Plan
5.Production of
Recommendations
6. Assessment of % of
Implementation
Re activation of a. Nominate members 1. Legislation to establish the 1. Immediate
National Cancer 2. Develop UAE strategic plan for cancer committee. action by the
Committee control for coming 10 years 2. Production of written UAE
3. Establish and enforce cooperation documents. government.
between care providers (e.g. MOH, 3. Establish and enforce
HAAD, DHA and private sectors). cooperation between different
authorities.
Introduction of Unique 1. Establish electronic data transfer. 1. Immediate
National Number 2. Improve computer and action by
telecommunications between MOH MOH.
and Health Authorities


Reestablish National 1. Establish Central Office at MOH 1. Establish methods of initial 1. Immediate
Tumor Registry 2. Establishing regional offices in each registration and active data action by
emirate. collection. MOH and
3. Establish tumor registry office in each 2. Data analysis. local
hospital. 3. Yearly reports. authorities.
4. Provide adequate staffing, equipment 4. Recruit qualified cancer coding 2. Provide
and computers, etc. technicians for each center. adequate
5. National awareness program. fund.
6. Yearly statistics (ie. OS, DFR, 3. Use cancer
death rates, etc.) prevalence
data to
initiate
epidemiologic
al studies.
Improve and upgrade 1. Upgrade available machines. 1. Set treatment protocols. 1. Provide funds.
radiotherapy 2. Buy new and latest machines to 2. Establish required quality 2. Appoint
equipment provide IMRT, IGRT, Tomotherapy, assurance programs. committee to
HDB. 3. Statistics and yearly report. write
3. Train staff at all levels. 4. 4 Doctors, 6 Radiographers and specification
4 Physicists and evaluated
tenders.
Establish National 1. Recruit highly qualified doctors, nurses 1. Narcotics are easily available to 1. Immediate
Palliative Care System and clinical pharmacists. patients as and when needed. action by
2. Rewrite access to narcotic policies MOH and
regulatory
bodies in the
UAE.
Increase awareness 1. By media (TV, Radio, Newspaper) 1. MOH + Health
2. Periodicals Authorities
3. Pamphlets and posters
4. Meetings
5. Anti‐tobacco campaign
6. Anti‐population campaign.

Funding Cancer Care Panel, 12 Month Project, March 2010‐March 2011:

• The action plan for the next twelve months is :
• Developing a fundraising training program for participating non‐
governmental organizations (NGOs) and hospitals.
• Defining and allocating the portfolio and resources of each organization
involved and prioritizing funding needs.
• Develop a pilot twinning training process with at least one representative
from an interested organization with the Children’s Cancer Hospital Egypt
57357 Foundation fundraising team.
• Establishing a regional chapter of the AFP (Association of Fundraising
Professionals) to build capacity, share fundraising science and experience
globally.
• Identifying some of the different regional strategies for funding cancer care
such as the community health insurance program.

• Action, time line, responsible.[will be made into a project chart]

1. Confirm with all panel members level of interest and participation for
the 12 month project. [combined with receipt of this report] Dr.
Sherif Abouelnaga
2. Developing a fundraising training program for participating non‐
governmental organizations (NGOs) and hospitals:
• Develop concept paper for regional fundraising training.
[within next 6 weeks] Dr. Sherif Abouelnaga and CCHF
fundraising team]
3. Defining and allocating the portfolio and resources of each
organization involved and prioritizing funding needs. [request will go
out with this letter and time line of 6 weeks] Dr. Sherif Abouelnaga
4. Develop a pilot twinning training process with at least one
Cancer Hospital Egypt 57357 Foundation fundraising team. [request
will go out with this letter and time line of 1 week to answer regarding
participation] Dr. Sherif Abouelnaga
5. Establishing a regional chapter of the AFP (Association of Fundraising
Professionals) to build capacity, share fundraising science and
experience globally. [ process has started with Dr. Sherif Abouelnaga
and fundraising team] time line for achievement: within 3‐6 months
6. Identifying some of the different regional strategies for funding
cancer care such as the community health insurance program.
• request will go out with this letter to put in writing the
different methods of raising funds in each country
• what has been successful and what has not
• what is governmental response to individual efforts for
fundraising for cancer projects such as medication support,
facility and equipment upgrade, etc.
• what is their most urgent fundraising need for this year for
their institution and patients and expected cost.

LONG TERM FOLLOW UP PLAN
• Determine the panel plans to sustain its momentum and continue its
work in the future. At least one follow up meeting should be planned
in the next 1 year. The meeting can be independent meeting or
adjunct to other conference or activity. Continued communication by
e‐mails is crucial to update members, exchange ideas and information
about related activities and news.
• Annual Update will be done in a special session at the Annual AMAAC
meetings where relevant projects and updates from the panels will be
presented.

Objective Action Steps Suggested Responsible Required Funding Timeline
person/entity
To develop a regional Dr. Sherif Abouelnaga 6 months.
fundraising training and CCHF fundraising
program to build a group department
of professional
fundraisers for cancer
care in each country.

To develop a countries’ ‐ develop the vision and 6 months to a year to
wide strategy for funding strategy as a whole for Committee composed gather information and
for cancer in Arab funding for cancer care. of: Although most will compile it into a
countries ‐ Identifying funding needs Representative from be done through document outlining
‐ Identify funding sources each Arab country. written situation,
and methodology for above Mixed representation correspondence, recommendations,
needs and strategies of healthcare should be some guidelines, etc.
‐ Develop guidelines or professionals, group meetings at
action steps for funding government, and user a central location.
who have had
experience in
fundraising.

CONCLUSIONS
Funding for cancer care is a complicated multi factorial issue for a disease that in any
country has a high cost in all aspects: diagnosis, treatment, supportive management,
and follow‐up. The effort to improve cancer care must be a coordinated effort
coming from all segments of society [government, private and public] , between
countries and regionally. The “too much countries” are willing to help the “not
enough” countries. However, to have a successful partnership, long term planning
should be in place with clear indicators of achievement. To understand the science
of fundraising in this current economic environment which has created strong
competition for worthy projects, committed individuals must receive training in
healthcare fundraising to achieve and sustain their goals. A regional fundraising
NGO needs to be established to allow capacity building and information sharing. The
long term strategy will define funding needs throughout the region on a country by
country basis and how these needs can be met by working together building on each
other’s “peer jealousy” and strengths to achieve a better life for all Arab cancer
patients.

REFERENCES

1. Global Cancer Facts 2005: World Health Organization
2. “Economic cost analysis in cancer management and its relevance today.” Indian
Journal of Cancer. Year : 2009 | Volume : 46 | Issue : 3 | Page : 184‐189
K Sharma1, S Das2, A Mukhopadhyay2, GK Rath1, BK Mohanti1
1
Department of Radiotherapy, Dr. B. R. Ambedkar Institute Rotary Cancer
Hospital (IRCH), All India Institute of Medical Sciences, New Delhi, India
2
Planning Unit, Indian Statistical Institute, New Delhi, India
3. “Cost of Cancer”. http://www.cancer.gov/aboutnci/servingpeople/costofcancer
4. “Transforming and Modernizing America’s Health Care System”,
http://www.whitehouse.gov/omb/fy2010_key_healthcare/
5. “HEALTH CARE FINANCING, EFFICIENCY, AND EQUITY” Sherry A. Glied Working Paper
13881 http://www.nber.org/papers/w13881 NATIONAL BUREAU OF ECONOMIC
RESEARCH
6. “Healthcare System” www.wikipedia.org
7. “Equity in community health insurance schemes: evidence and lessons from
Armenia” Jonny Polonsky1, Dina Balabanova1,*, Barbara McPake2, Timothy
Poletti3, Seema Vyas1, Olga Ghazaryan4 and Mohga Kamal Yanni4 Health Policy
and Planning 2009 24(3):209‐216; doi:10.1093/heapol/czp001 1 London School of
Hygiene and Tropical Medicine, Keppel St., London WC1E 7HT, UK.
2
Institute for International Health and Development, Queen Margaret University College,
Musselburgh, Edinburgh, EH21 6UU, UK.
3
Australian Permanent Mission, 2 Chemin des Fins, 1211 Geneva, Switzerland.
4
Oxfam GB, Oxfam House, John Smith Drive, Oxford, OX4 2JY, UK.
8. Community Health Insurance in India: An Overview
http://www.srtt.org/downloads/communityhealth.pdf
9.10.www.afp.org
Cancer Funding: Does It Add Up? New York Times March 6, 2008, 12:21 pm By
TARA PARKER‐POPE
11. Access and equity to cancer care in the USA: a review and assessment
12. Postgrad Med J 2005; 81:674‐679 doi:10.1136/pgmj.2005.032813 LA Siminoff,
L. Ross
13. “The impact of socioeconomic status on survival after cancer in the United
States :Findings from the National Program of Cancer Registries Patterns of
Care Study.”Cancer Volume 113 Issue 3, Pages 582 – 591, Published Online:
25 Jun 2008
14. “Cancer Disparities by Race/Ethnicity and Socioeconomic Status” CA Cancer J Clin
2004; 54:78 doi: 10.3322/canjclin.54.2.78.Elizabeth Ward, PhD, Ahmedin Jemal, DVM,
PhD, Vilma Cokkinides, PhD, MSPH, Gopal K. Singh, PhD, MS, MSc, Cheryll Cardinez,
MSPH, Asma Ghafoor, MPH and Michael Thun, MD, MS
15. “Effects of Socioeconomic Status and Treatment Disparities in Colorectal
Cancer Survival” Cancer Epidemiology, Biomarkers & Prevention August 2008
17; 1950 doi: 10.1158/1055‐9965.EPI‐07‐2774 LE Hoa, Argyrios Ziogas, Steven
Lipkin, Jason Zell.
16. ALSAC‐St. Jude Research Hospital . www.Charity Navigator Rating ‐ ALSAC ‐ St_
Jude Children's Research Hospital.mht
17. Jerry Lewis MDA Telethon. www.wikipedia.com,
http://www.mda.org/telethon/
18. OECD Data Frequently Requested Information,
http://www.oecd.org/document/16/0,3343,en_2649_34631_2085200_1_1_1_
1,00.html
19. OECD Health at a Glance 2009. www.oecd.org
20. 19. “2008 Fact Sheet on Healthcare Giving in the USA and Canada” Association
of Healthcare Philanthropy, www.ahp.org
21. 20.Future Donors Table , Association of Healthcare Philanthropy , www.ahp.org
22. Association of Fundraising Philanthropy www.afp.org

AVAILABLE RESOURCES

Following is a list of resources in individual countries. The references also have a
large number of resources that can be accessed regarding funding and fundraising
for cancer care.
Type Affiliation
Entity Name Company Non‐ Location / Phone, Fax, Email expertise and
Organization, governmental, Address Website interest
University Private
Kingdome of Saudi Ministry Government Dammam www.mosa.gov.sa Supervising all
Arabia Ministry of Social charitable
Affairs foundations

Advanced Medical Care Charity NGO Teshreen Avenue Tel: +963‐33‐2285590 Chronic illnesses
Center (AMCC)/Al‐Bir Hama‐Syria Fax: +963‐33‐228591 support education
Charity of Hama‐Syria www.birhama.com
info@birhama.com
BASMA (for children Charity NGO Damascus ‐Syria P.O.Box: 124,
with cancer) Damascus, Syria
Phone: (011) 5078 –
(0988) 005078
Fax: (011) 6628000
Email:
info@basma‐syria.org
Website:
www.basma‐syria.org
Al Afia Fund Charity NGO Damascus ‐Syria Tel.:+963‐11‐8837631
CCHI Organization Government
Tawuniya Company Private
BUPA Company Privte
MedGulf Company Private
Health Committee @ Organization Non Government
Council of Chambers of
Commerce
MOH,UAE Government Abu Dhabi, UAE Dr. Amin Amiri CEO – Medical
Practice and
Licensing
Dubai Heath Authority Government Dubai, UAE Dr. Awatif Abo Halika Head of Health
Planning and
Research
Red Crescent Organization Non‐ Abu Dhabi, UAE Dr. Mohamed Khalifa Secretary General
governmental Al Qamzi amana@uaerc.org.
ae
Friends of Cancer Organization Non‐ Sharjah, UAE Ameera bin Karam President of Board
Patients (FOCP) governmental ameera@binkaram
.com
Children’s Cancer Fundraising Non Sherif Abouelnaga M.D. The foundation is
Hospital Egypt 57357 Department governmental Sayeda Zeinab, Executive Director of responsible for the
Foundation Cairo, Egypt Fundraising fundraising of the
011 2010 214 9920, hospital which is

snaga@57357.com, entirely funded by

www.57357.com donations

Type Affiliation
Entity Name Company Non‐ Location / Phone, Fax, Email expertise and
Organization, governmental, Address Website interest
University Private
Board of Non 33 Kasr El Aini Sherif Abouelnaga Provides financial
Association of Friends of Directors governmental Street M.D. support for
the National Cancer Cairo, Egypt Secretary General program
Institute 114441 011 2010 214 9920, implementation,
snaga@57357.com, equipment,
www.57357.com education and
needs of cancer
patients at the
National Cancer
Institute and the
Children’s Cancer
Hospital Egypt
57357
The Association of www.afp.org
Fundraising www.ahp.org
Professionals and the
Association for
Healthcare Professionals
recognize the significant
impact that fundraising
has on the viability of
the healthcare system
and have significant
resources for healthcare
fundraising.

Standards of Care and Guidelines Inaugural Meeting Report
Standards of Care and Guidelines for the

Arab World with Limited Resources
Standards of Care and Guidelines for
the Arab World with Limited
Resources
Dr. Nagi S. El Saghir and Dr. Hamdy A. Azim
*on behalf of the Standards of Care and Guidelines for the Arab World with
Limited Resources Panel Members

PANEL OBJECTIVES
Discuss briefly the impact of limited resources on standard of care.
Present regional experience in setting guidelines (e.g. MENA NCCN).
Present recommendations addressing standard of care issues in the
Arab Countries.

PANEL MEMBERS

Facilitators
American University of Beirut
Dr. Nagi S. El Saghir Section Head & Consultant Lebanon
Medical Center
Dr. Hamdy Azim Professor, Oncology Cairo University Egypt
Dr. Benjamin Anderson Director of Breast Health Clinic SCCA Seattle Cancer Care Alliance USA
Panel Members
Dr. Lobna Sedky Consultant, Medical Oncology Cairo University Egypt
Dr. Ahmed Saadeddin Consultant, Adult Medical Oncology Riyadh Military Hospital Saudi Arabia

Consultant, Division of Adult Medical
Dr. Ashwaq Al Olayan King Abdulaziz Medical City Saudi Arabia
Oncology
Dr. Ayda Mustafa Hussein Khartoum Teaching Hospital Sudan

Junna Ibardolasa ibardolasaj@ngha.med.sa +96612520088 Ext 14069 / Fax: +96612520088 Ext
14691

Panel Guest
Name Organization
Dr. Jalaa Taher Health Authority of Abu Dhabi
Dr. Kamal Abdelrahman Ali RICK‐Sudan
Dr. Abdulrahim Gari Gari Medical Center
Dr. M. Alwatban KAMC

Name Organization
Dr. Salha Boujjassoum Al Bader Al Amal Cancer Center
Dr. Ahmed Al‐Sagheir KFSH‐Dammam
Dr. Ahmad Tassi NGHA
Dr. Shereena Al Mazrouie Health Authority of Abu Dhabi
Rima Khadra ROCHE
Dr. Fady Geara American University of Beirut Medical Center
Jehad Alshawi KAMC
Dr. Ahmed Absi KKH‐NGHA
Dr. Nada Osman Yousef‐Elhaj NCI‐Sudan
Dr. Nafisa Abdelhafiez KAMC‐Riyadh
Dr. Rafa Ashehri KAMC‐Riyadh
Dr. Al Askar Nasser KAMC‐Riyadh
Dr. Yaser Abdulrazak Advanced Medical Care Center
Dr. Mohammed El Naghy KAMC‐Riyadh
Dr. Samia Al‐Amoudi KAUH, Jeddah
Dr. Hanadi Attiyah KFSH&RC
Dr. Alaa Bazaid KAMC‐Riyadh
Dr. Raul Ribeiro St. Jude’s Children Research Hospital, USA

INTRODUCTION
The Panel met in Riyadh on March 24, 2010 in the presence of the above Members
and Guests.
Facilitators gave a powerpoint presentation of current status of Guidelines for the
treatment of Cancer patients in Arab countries including proficiencies and
deficiencies that were considered as challenges for improving and Implementation of
Guidelines and Recommendations in order to improve care of cancer patients in
Arab Countries.

Summary of Challenges:
Guidelines for cancer treatment includes guidelines for Prevention and early
detection, Pathology, Imaging, Staging work‐up, Surgery, Radiation therapy, Systemic
Therapy (Chemotherapy, Hormonal Therapy, modern Targeted therapy,
Immunotherapy, etc), Supportive and Palliative Care
The Panel agreed that the major challenges lies not only in writing guidelines, but
also in implementing guidelines.

Current Status of Guidelines in Arab Countries
The Panel agreed that there is in general an absence of printed guidelines in most
Hospitals and Medical Centers as well as private small centers and clinics.
The Panel agreed that presently, care of cancer patients depends on each particular
treating physician, available resources, ability of patients to access care, patient’s
ability to pay for tests and treatment in many countries, special referrals to particular
hospitals in some countries, and ability to reach particular well known physicians and
hospitals in many places.


Delivery of Standards of Care & Guidelines: Education and Training as a major
aspect of delivery of cancer care
Panel agreed that delivery of care is affected by medical education & training
background of health care providers and that to improve care we have to address
the sources of medical knowledge acquired by physicians in Arab countries which are
medical school curriculae, hospital training programs, and post‐graduate continuing
medical education (CME) which has become a matter of lifetime education and
made physicians eternal students and teachers.
Physicians in Arab countries have MD Degrees either from Medical Schools and
Hospitals in Arab countries that have variable degrees of ratings from minimal to
maximal; or from USA, Canada, Western Europe, or Australia, which generally have
high levels of ratings with recognized basic levels of teaching and excellence; or from
Central and Eastern Europe with various degrees of minimal to better ratings.
Physicians in Arab countries have various specialty diplomas and board certifications
from hospital and university training programs similar to medical schools of origin.
Requirements for continuing medical education CME in Arab countries are still at
their beginnings. Panel discussed and summarized the sources of Medical knowledge
in Arab countries as being textbooks and medical journals, international meetings,
regional and local society meetings & CME conferences, Hospital regular conferences
& tumor boards, Internet, Pharmaceutical companies meetings, satellite symposia,
and even some physicians may get their information from representatives of
pharmaceutical visiting them in their clinics. Panel agreed that Physicians in many
Arab countries have serious financial concerns. Many have low incomes, worry about
expenses raising family, children’s education, retirement savings, medical expenses
of their own health, and others. Physicians taking time off work for conferences may
mean financial losses. All efforts aimed at improving education should take care of all
those various aspects.

Improvement of Medical Education Background
Physicians’ Education: Panel recognized that licensures for MDs and for various
specialties are of variable rigorousness in different countries. CME requirements are
variable. Physicians update themselves upon their own initiatives and motivation.
Panel agreed that strict licensing and adoption of Arab Board Examinations are very
important ways to improve care of cancer patients in Arab countries.
Also, hospital privileging, control of credentials, and quality control are variable from
country to country and from hospital to hospital and it varies from excellent to poor.
Morbidity and mortality exercises are rarely practiced in hospitals in Arab Countries.
Monitoring of outcome is limited to a few major academic centers who perform and
report clinical research
Panel also noted that medical liability in many Arab countries is limited. Physicians
and hospitals may easily get away with medical errors: Few systems to protect
patients, no fair compensations of patients and families for errors; however, some
countries have harsh and excessively disproportionate penalties. The fatalistic
attitudes of families forgives for poor health care delivery in many instances.

Patient Education: Patient Education is variable but limited in most places. Printed
and clear patient information is present in only a few places. Media is helpful but
systemic efforts by authorities are lacking

METHODOLOGY: WRITING AND ADOPTING GUIDELINES
Options for guidelines use were discussed. The options are either to have guidelines
specifically written by and for Arab countries or to adopt or adapt international
guidelines such as NCCN comprehensive guidelines. ASCO and ESMO guidelines, FDA
and EMEA approval of drugs and indications, and WHO essential lists of drugs are
important for some countries and situations.
Panel discussed also the need to consider resources in many Arab countries and to
adopt certain innovative models such as resource‐driven Breast Health Global
Initiative (BHGI) Guidelines.
Stratifications suggested include resources, access to hospitalization, access and
ability to pay for tests and medications, easiness or difficulty of access for rapid
treatment of complications.
Need for database was discussed in order to monitor implementation of guidelines
and patient outcome and survival in various different regions and countries.
Panel agreed to study in depth the methodology of the Breast Health Global
Initiative, define levels of resources as Basic, Limited, Enhanced, Maximal in various
countries and regions and determine needs in each place and country in order to
better allocate resources. This would allow to establish guidelines according to levels
of resources and to implement guidelines for recommendations and monitoring.
(References from Cancer Supplement 2008)
Facilitators and Panel discussed options of adopting international published
comprehensive guidelines such as NCCN Guidelines, ESMO minimal
recommendations, and ASCO various guidelines publications and agreed that there is
no point of re‐writing those guidelines that are available and written by experts in
various fields. However, Panel agreed that we should make relevant amendments
that consider specificities of our countries and positively viewed the experience of
NCCN‐MENA region Guidelines.
In summary, Panel agreed for adopting international NCCN guidelines, NCCN‐MENA
region guidelines that are available for a few specific cancers, and pay attention to
resources with Breast Health Global Initiative BHGI resource‐driven guidelines, as a
MODEL for breast and other cancers to help setup priorities.
Panel discussed and agreed that there is need for more active education methods
and considering pilot projects and implementation of guidelines.

Implementation of Guidelines
Panel agreed that there is no point of having guidelines unless we have mechanisms
for diffusion and implementation of diagnostic and treatment recommendations.
Panel agreed that guidelines should be disseminated to physicians wherever they are
working so that every patient with cancer gets the best treatment.
For dissemination and implementation of Guidelines for hospital‐based physicians,
the panel considered that it is easiest to write and monitor them through the writing
of Clinical Pathways for hospital‐based physicians. For individual clinic‐based

physicians, the task becomes a little more difficult and could be done through
outreach innovative methods.
The panel agreed that it is very important to make sure we have mechanisms that
encourage people to apply guidelines and to monitor applications and patients’
outcome. Panel agreed that Tumor Board Conferences help to disseminate, discuss,
and implement guidelines.

Monitoring of Guidelines Implementation
It could be done by committees of peers in some hospitals, or by committees of
peers of medical societies, or by government insurance bodies whose goals may be
to save budget money and better allocation of resources by enforcing guidelines
implementation. Private insurance companies are also interested because they
would use guidelines to save money, where approved.
Requirements for implementation of guidelines: In order to monitor good clinical
practice and implementation of practice guidelines, we would require proper
documentation of care in medical records. This is available only in major medical
centers and lacks in a larger majority of hospitals and clinics that care for cancer
patients in Arab countries. Monitoring bodies will need to have confidential access to
medical records to monitor the application of clinical pathways.

Further issues identified as obstacles for Guidelines implementation: Resources,
education, etc
The better patients are educated the better treatment level is. Panel acknowledges
that although we have good numbers of patients who are knowledgeable and search
books and internet, the largest proportion of our patients still have limited general
medical education. More public and patient education, more access to information
and internet are needed. Nursing staff are a very part of health care providers and
should be encouraged to participate in the process. Incorporation of resources and
technology availability into guidelines is important, particularly when taking care of
cancer patients in countries with limited resources and remote areas. Panel
discussed the issue of responsibility of physicians for certain delays and suboptimal
therapy and ways to improve it by education, guidelines, and proportionate
accountability for medical errors.

In summary, Guidelines need to be written and adapted. Guidelines needs to be
disseminated and implemented. Guidelines implementation requires situation
analyses and measurements of impact and patient outcome. In addition to post‐
graduate Continuing Medical Education, reviews and updates of Medical School
curriculae to include oncology, and setup of standard requirements for oncology
training programs are essential for future improvement of the care of cancer
patients in the Arab World


RECOMMENDATION STANDARDS OF CARE AND GUIDELINES FOR THE ARAB
WORLD WITH LIMITED RESOURCES

2020 objectives: Practice Guidelines and improvement of background Medical
Education (Medical curriculum, clinical training and post‐graduate education)
Objective #1: Introduce Oncology course requirements in Medical School Curriculum
and Licensure
Objective #2: Arab Board program and exam for Post‐Graduate Training, including
cancer care recognition in all Arab countries
Objective #3: Introduce Post‐Graduate CME minimum requirements and regulations
in all Arab Countries
Objective #4: Adopt a well established International Guideline Program namely
NCCN
Objective #5: Adopt a process like NCCN‐MENA region Guidelines. Objective# 5:
Adopt BHGI‐like resource driven guidelines for Breast and as a model for other
cancers for countries with limited resources. Feasibility: Pilot project 12‐months
Goal
Objective# 6: Adopt BHGI‐like resource driven guidelines for Breast and as a model
for other cancers
Objective #7: Orientation to Unify the NCCN‐MENA version Guidelines all over the
region with emphasis on the application of the treatment options most suitable
economic, social & cultural wise.
Objective # 8: Develop new Guidelines for Arab countries
Objective #9: Develop Guidelines Implementation strategies & monitoring
Objective #10: Clinical Pathways in Hospitals & private oncology clinics and monitor
their application: discussed
Objective #10: Establish regionally a limited number of Cancer Centers and
Institutions of known strong training programs to offer fellowship programs for
candidates to fortify the weak centers
Objective #11: Accreditation of comprehensive cancer centers: discussed

Ensure that the standards of care and management of the majority of cancer
patients in Arab countries are based on evidence‐derived guidelines.

Action Steps:
1. Establish a multidisciplinary regional Guidelines Steering Committee.
2. Adapt currently accepted guidelines to meet cultural expectations and
resource availabilities.
3. Modify guidelines based on emerging evidence from the region.
4. Establish effective and sustainable outcomes monitoring and evaluation
systems.


12 MONTH PROJECT
• Develop training program for oncology care professionals about
guideline development and implementation.
• Identify an internationally accepted guidelines to be adapted for the
region.

REFERENCES
1. Anderson BO, Yip C, Smith R et al. BHGI Early Detection & Level of Resources.
Cancer 2008; 113: 2221 – 2243.
2. Eniu A, Carlson R, El Saghir N, et al. BHGI Treatment of breast cancer by
stages. Cancer 2008; 113: 2269.
3. El Saghir N, Eniu A, Carlson R, et al. BHGI Locally Advanced Breast Cancer.
Cancer 2008; 113(suppl):2315‐2324.

Tumor Registry Inaugural Meeting Report

Tumor Registry


Tumor Registry
Dr. Ali S. Zahrani
*on behalf of the Tumor Registry Panel Members

Objectives
Discuss the importance of tumor registries and their functions.
Present current registries in the Arab countries.
Present recommendation of how to improve registries functions and
collaborations.

Panel members
Facilitators, Panel Members, Guest Panel Members, and Experts including Name,
title, institution and country

Facilitator
Supervisor, Gulf Center Saudi
Dr. Ali S. Al‐Zahrani KFSHRC / GCCR
for Cancer Registration Arabia
Panel Members
Data Manager, King Abdulaziz Medical Saudi
Ms. Susan Young
Oncology Department City, Riyadh Arabia
Administrative Director Saudi Cancer Registry Saudi
Dr. Haya Al Eid
& Epidemiologist KFSH & RC, Riyadh Arabia
Director Ministry of Health,
Dr. Mohammed Tarawneh Jordan
Cancer Registry Amman
INDOX Cancer Research
Dr. Raghib Ali Director U.K.
Network, Oxford
Gina Gantan gantangi@ngha.med.sa + 96612520088 Ext. 14107/Fax: + 96612520088 Ext 14691
Guest Panel Members
King Hussein Cancer
Dr. Fadwa Attiga Director Jordan
Institute
King Saud Abdulaziz Saudi
Dr. Amani Babgi Consultant
University Hospital Arabia
Hamad Medical
Dr. Al Hareth Al‐Khater Consultant Qatar
Corporation
American University of
Dr. Nagi Saghir Clinical Professor Lebanon
Beirut
Saudi
Dr. Ali Mohd Alwadey MOH Representative Ministry of Health
Arabia



Abstract:
Background: As part of the initiative to Improve Cancer Care in the Arab World (ICCAW), a
tumor registry panel was formed by a group of individuals from varying countries,
backgrounds and experience to develop recommendations on how to improve the quality
of cancer data.

Methods: An assessment tool, including situational analysis, objectives,
recommendations, including specific action steps and indicators, along with current
resources available internationally, was completed by panel members. Responses were
compiled, discussed and the panel reached a consensus on final recommendations.

Results: The panel agreed on the need to improve cancer data in the region and drew
up recommendations regarding education, data standards, data quality control, and
automation of data collection

Conclusion: The Tumor Registries panel presented recommendations and available
resources to help countries in the Arab world improve cancer data to support cancer care.

Introduction:
Cancer is a major health problem in both developed and developing countries. The
estimated number of new cases of cancer each year is expected to rise from 11 million in
2002 to 16 million by 2020 with more than half of the cases arising in developing countries.
In the Eastern Mediterranean Region (EMR) cancer incidence is predicted to rise by 1.8 fold
in the next 10 years. Every year cancer kills more than 6 million people worldwide; it is the
second most frequent cause of death in a majority of developed countries and the 4th
leading cause of death in the EMR.

Cancer registration can be defined as the process of continuing, systematic collection of
data on the occurrence and characteristics of reportable neoplasms with the purpose of
helping to assess and control the impact of malignancies on the community. (Jensen 1991)
Thus, cancer registration is the primary step in any strategic plan aimed at fighting cancer
through the effective and targeted implementation of preventive measures and cancer
control programs. The primary objective of a national cancer registry is to collect and
classify information on all cancer cases in order to produce statistics on the occurrence of
cancer in a defined population, to provide technical support for early detection and
screening programs, and to facilitate epidemiological studies on cancer. The ultimate goal of
the analysis of cancer data is to prevent and control cancer, including the improvement of
cancer patient care (Hutchinson, C.l. et al, Cancer Registry Management: principles&
practice, second edition, National Cancer Registrar’s Association, 2004 p 5)



Basically, two types of cancer registry collect and maintain analyzable cancer data. Hospital‐
based registries provide valuable sources of information regarding methods of diagnosis,
stage distribution, treatment methods, response to treatment, and survival, whereas,
population‐based registries collect data on all cancer cases diagnosed with within a defined
population or geographic area. It is essential to provide incidence and prevalence rates of
cancer in a defined population. These data are useful in studying cancer patterns, trends,
and measuring the cancer burden on healthcare systems. Population‐based registries are
highly desirable in the development of National Cancer Control Programs. Each country
should endeavor to introduce at least one representative population‐based cancer registry.
Medical centers with advanced facilities for cancer management should also establish a
comprehensive database (hospital‐based registry) for all cancer patients treated on its
premises.

The purpose of this report is to highlight issues related to the collection of cancer data in
the Arab world and to put forward/propose recommendations to improve the collection
and promote the utilization of cancer data maintained by hospital‐based and population‐
based registries.

2. Methods and Materials:
Panel Formation:
As part of the Initiative to Improve Cancer Care in the Arab World, a Tumor Registries
panel was formed from individuals from different areas and backgrounds involved in
cancer registration the region.

Panel Objectives:
To discuss the importance and functions of tumor registries
To present current registries’ experience in the region.
To present recommendations on how to improve cancer data , including registry
functions and collaborations.

Initial Assessment and Recommendations Tool: (IART)

i.) To conduct a brief situational analysis including challenges and strengths.
j.) To provide strategic recommendations to address objectives including specific action
steps and indicators.
k.) To specify a do‐able objective to be achieved in the next 12 months.
l.) To compile of a list of available resources, anywhere in the world, which may provide



Arab countries span a large geographical area with heterogeneous socioeconomical and
political characteristics. However, there is a common ground among the countries; a
feeling of belonging to one nation with a common cultural and historical background. In
order to assess the current status of cancer registration in these countries, the panel
members completed the initial assessment tool including a situational analysis.

The findings of the situational analysis can be summarized as follows:
1. Strengths and success:
1.1 Establishment of national cancer registries in almost 50 % of Arab countries
1.2 Mandatory reporting by all health sectors in Gulf Cooperative Council (GCC)
states
1.3 Government support to facilitate cancer registration through establishment of
regional offices representing major health care systems in some countries.
1.4 Publication of annual cancer incidence reports as well as journal articles,
abstracts and posters communicating their findings.
1.5 Acceptance of cancer incidence data from Kuwait, Oman and Bahrain by WHO‐
IACR for inclusion in Cancer Incidence in Five Continents.
1.6 Experience gained by countries with long‐established national cancer registry
programs has been shared with countries that have recently started or are
planning to start programs.
1.7 Registrars in selected registries have received formal training in cancer registry
and some have obtained the Certified Tumor Registrar (CTR) credential.
1.8 Collaboration established between hospital‐based and population‐based
registries in countries such as Kuwait and Saudi Arabia

Almost 50% of Arab countries have already established National Cancer Registries which
allow monitoring of time trends in cancer incidence and survival as well as geographic
and socio‐demographic variability. Some countries, i.e. GCC states have made cancer
reporting mandatory, through passive registration, by all health sectors. Governmental
support helps to facilitate cancer registration through establishment of regional offices
representing major healthcare systems in some countries. Several countries publish
annual cancer incidence reports, and communicate their findings as journal articles,
abstracts, and posters. Cancer data from some countries (Kuwait, Oman and Bahrain)
have been accepted by WHO‐IARC cancer incidence reports (Cancer Incidence in Five
Continents, Vol IX IARC Scientific Publications No. 160). Some countries have gained
extensive experience in cancer registration and are able to share their experience with
countries that have recently started or are planning to start National Cancer Registration
Programs. Tumor registrars at well‐established NCRs have received formal training and


some are certified by the U.S. National Cancer Registrar’s Association. Due to the long
history of running national programs, collaboration has been established between
different healthcare facilities in some countries such as Kuwait, and Saudi Arabia. Such
well‐established registries have adapted and implemented extensive quality control
measures to ensure high quality of cancer data.

Some registries are located on the premises of established medical centers which enable
them to benefit from the technical and scientific support available at these centers.
Often these medical centers have well‐established hospital‐based tumor registries with
prominent cancer programs enabling more in‐depth analyses of cancer data. This
analysis is not just limited to incidence and mortality but also involves modeling and
predictions with some diagnostics and management co‐factors. Recently, efforts have
been extended to match cancer cases to the national vital statistics registry enabling
more accurate survival and mortality data.

However, the panel listed and discussed many weaknesses and threats to the existing
population‐based registries that may delay or prevent some countries from establishing
their national registries.

The main threats to any registry is the prospect of to ensure its existence. Shortage or
limited budgets are the main concern facing health planners in sustaining the National
Cancer Registry. Moreover, shortages of well‐trained staff, either due to low wages and
benefits, or to increased demands for trained registrars because of continuous
expansion and opening of new cancer care centers.

Bureaucracy and misconceptions have negative effects on accessibility to cancer data
and in adapting new technologies to improve cancer registration. Death certificates, in
most countries, are considered as unreliable source data and are usually neglected. This
has led to another conceptual issue encountered by some population‐based registries by
not including death Certificate as independent source of case finding which would
explain in part some of the underreporting of cancer cases that has no medical profiles.
Moreover, tracing cancer cases in hospitals with no computerized medical records
system or proper archiving is another major problem that exhausted productivity of
tumor registrars.

Another weakness that always dissatisfies decision makers is delays in publishing annual
incidence reports.



Health care data infrastructure that will allow electronic data capture. These are mainly
due to delay in receiving cancer data identify the root cause from regional offices in
addition to the extensive manual auditing and consolidation of data conducted by
limited number of trained tumor registrars. In addition to that some important
information is either incomplete or missing (e.g. extent of disease and staging). This
situation is aggravated by absence or inadequate regular audit and quality control
monitoring of cancer data to enable for better estimation of data validity and
completeness. Suboptimal follow up of cancer patients’ status prevents reporting
mortality and survival rates which are another shortcoming of cancer registries, and
moreover most national cancer registries do not collect important information on
established risk factors such as smoking which might have negative impact on
supporting cancer registration.

Lack of or inadequate local continuing education programs and activities designated for
tumor registrars is a major weakness in the Arab Countries. With exception of some free
on‐line training courses that are usually designed for developed countries such as SEER
programs for Certified Tumor Registrar diplomas and these programs are unaffordable
by most tumor registrars in the low income countries. Lack of knowledge among
registry staff of the resources out there. Despite increased demands of tumor registrars
no local programs has been established in the Arab world.

Discussions and Conclusions:
Population‐based cancer registration is an integral component of any National Cancer
Control planning. All Arab countries should endeavour to introduce at least one
representative population‐based cancer registry. Establishing a network system of cancer
registries for Arab world to exchange experience between cancer registry professionals in
the Arab countries is probably one of the initial steps that health professionals should strive
to establish. This initiative can lead to establishment of regional data standards for cancer
registration in Arab countries.
Assessment of the quality of reported cancer data and quality control measures in the
national cancer registries according to WHO standards is another mandatory step to have
better estimation on how reliable and how complete the data are.
Cancer registration is a systematic and continues collection of cancer data which consumes
a lot of public funds, therefore proper utilization of collected data has to be ensured.
Sustainability of national cancer registry by providing all needed logistics, recruiting new
staff and investing in training current registrars are equally important.
In some countries there is always a question about who owns the data? In our opinion
anonymous row data should be made available for academic researchers to enable them to
design, evaluate, and improve cancer prevention programs. Regular release of cancer
incidence reports should be also one of the targeted goals. These reports should improve in


quality and information provided. Estimates from cumulative incidence reports (5, 10‐year
reports) are more informative than annual reports, this kind of reports should be
encouraged. Moreover, these reports should include mortality and survival rates, secular
trends, and spatial clustering of different cancer types.
Establish regional training and development programs for tumor registrars to improve
productivity of current tumor registrars and to overcome shortage of trained staff there is
necessity to establish local training programs targeted to tumor registrars. Due to its
immediate importance, the panel has selected this initiative as a 12‐month objective that
would help to overcome many of the current obstacles facing tumor registries. Such
imitative mandate formation of steering committee to oversee development of the training
program which includes development of the curriculum, by selecting relevant materials and
generating evaluation processes. The steering committee should also set the requirements
for training centers as well as credentials required for trainers.
Due to the increased availability of electronic databases in medical centers which allow for
electronic data transfer from data sources to NCRs. The panel has selected establishment of
Pan Arab Automated Cancer Registration (PAACR) as an objective for 2020. This initiative
aims to reduce proportion of manual case finding and manual quality assurance procedures.
It will also unify cancer registration standards in the Arab world.
The following steps need to be taken before going to full automated system that links all
cancer registries in the Arab countries. First, all participating countries should have the
technologies and facilities to develop their current systems to fully automated registration
systems. Competitive software that has the capabilities of integration with different
electronic medical record systems should be developed for this purpose.
A steering committee needs to be established to oversee the entire process of such
transformation. The committee has to decide on the minimal required data that can be
shared between countries. Regional data collection, reporting, and data transfer standards
have to be implemented by all participating countries. Moreover, standards for data
utilization and reporting must be agreed on by all parties.
Rapid improvement in healthcare has increased life expectancy at birth; rapid changes in
modified lifestyles such as high consumption of unhealthy food along with other
environmental risk factors have resulted in an increased incidence of cancer in most of Arab
countries. Cancer registry remains the foundation for any cancer control program. All Arab
countries should endeavour to introduce at least one representative population‐based
cancer registry. National Committees for Cancer Control and Prevention should address the
need for collaboration among primary, secondary and tertiary care facilities, to provide a
venue for data collection, and to drive the formation of cancer registries.
Countries with established population‐based registries should invest more on the stability.
The main threat to cancer registration is the availability of resources and trained personnel.
This would necessitate establishment of training and development programs for tumor
registrars and cancer epidemiologists in the region. Data quality is another main concern
where regular auditing and evaluation of completeness and validity of collected data is
highly recommended.



Table: Panel Recommendations


1. Establish a network • To exchange experience between
of cancer registries for cancer registry professionals in the
Arab World. Arab countries.
2. Establish Pan Arab • Implementation of new information
Automated Cancer technologies in networking and
Registration (PAACR). website registrations between
(European Cancer
regional offices within participated
Incidence and
Mortality database) countries.
• All population‐based cancer
registries are automatically eligible
to become members of the PAACR.
3. Assessment of 1. Number of centers
quality of reported • To see how reliable & how complete adheres to the cancer
cancer data and quality registration protocol.
our National Cancer in Databases.
control measures in the 2. Number of trained
staff on quality control
national cancer
measures.
registries according to
3. Percentage of
WHO standards. completeness of
registered cases by
center and region.
4. Percentage of minor
and major
disagreements
between abstracted
and re‐abstracted
data.
4. Increase utilization • De‐identified Raw data (Aggregate) 1. Timely reporting. Developing website for
of cancer registry data should be made available to 2. Number of decisions Arab countries‐cancer
by decision makers and taken based on registries (one website
clinicians and researchers to ensure information from
academic researchers for all registries)
maximum utilization. cancer registries.
to improve cancer
3. Number of data
prevention programs.
requests and cancer
studies from cancer
registries.
1. Revised pay‐scale,
5. Sustainability of • Providing all needed logistics. annual increments
Cancer Registry and benefits.
• Recruiting and training of new 2. Number of training
courses and
registrars. Encourage current workshops.
tumor registrars to be certified. 3. Number of
permanent jobs per
center.
4. Proportion of
national staff to
expatriate.




6. Regular release of • Encourage regular release of
Cancer Reports cumulative reports (3, 5, 10 year
reports) even if annual reports
are required).
• Monitor secular trends of cancer
incidence by site, gender and
geographical distribution.
• Study survivals of different
cancers.
7. Establish regional
data standards for Arab
World.
8. Establish regional • To improve productivity of
training and current TRs and overcome
development programs shortage of trained staff.
for tumor registrars.

REFERENCES

1. Ferlay J, Bary F., Pisani P, Parkin DM Cancer Incidence, Mortality and Prevalence
Worldwide, (IARC
Press, Lyon, 2004)

2. Jensen OM, and Storm HH. Cancer registration: principles and methods.
Reporting of results, (IARC Press, Lyon, 1991;(95):108‐25)

3. McLaughlin RH, Clarke CA, Crawley LM, Glaser SL. Are cancer registries
unconstitutional?, Soc Sci Med. 2010 May;70(9):1295‐300.

4. Sobue T. Current activities and future directions of the cancer registration
system in Japan. Int J Clin Oncol. 2008 Apr;13(2):97‐101.

5. Valsecchi MG, Steliarova‐Foucher E. Cancer registration in developing countries:
luxury or necessity?, Lancet Oncol. 2008 Feb;9(2):159‐67.

6. Al‐Zahrani AS, Khoja TA, Al‐Madouj AN, et al. Eight Year‐Cancer Incidence
Among Nationals of the Gulf Cooperation Council Countries, 1998‐2005.
Riyadh: Gulf Center for Cancer Registration,
June 2009.

Available Resources
The following resources may offer help in tumor registry related issues.
Type Affiliation
Individual, Governmental, Non‐ Contact Information Specific areas of
Entity Name Company governmental, Location / Phone, Fax, Email expertise and
Organization, Private Address Website interest
University

IARC Organization Part of WHO Lyon, France www.iarc.fr Cancer
Registration

North American Organization Governmental USA/Canada www.naaccr.org Central cancer
Association of registry
Central Cancer standards,
Registries training,
(NAACCR) resources, data
National Cancer Organization Governmental Washington, DC, seer.cancer.gov Cancer registry
Institute / USA standards,
Surveillance, training
Epidemiology & resources, data
End Results
(NCI/SEER)

International Organization Lyon, France www.iacr.com.fr Cancer Registry
Association of International software
Cancer Association for (CanReg4 & 5)
Registries (IACR) Research on training
Cancer (IARC) programs.

Research Governmental Governmental and GCC States Research Centers and Governmental
Centers and and Universities non‐governmental Chairs and Universities
Chairs

National Cancer Organization Non‐governmental USA www.ncra‐usa.org Cancer Registrar
Registrar’s Certification,
Association registry
resources,
training

Centers for Organization Governmental Atlanta, Georgia, www.cdc.gov/cancer/ Software, registry
Disease Control USA npcr/npcroncology training resources
– National
Program for
Cancer
Registries (CDC‐
NPCR)

Type Affiliation
Individual, Governmental, Non‐ Contact Information Specific areas of
Entity Name Company governmental, Location / Phone, Fax, Email expertise and
Organization, Private Address Website interest
University
American Organization USA www.facs.org/cancer/ Cancer Program
College of coc/coc.edu Standards,
Surgeons – training resources
Commission on particularly TNM
Cancer (ACoS‐ & collaborative
CoC) staging.
European Organization Lyon, France www.encr.com.fr Registry
Network of International Standards
Cancer Association for
Registries Research on
(ENRC) Cancer (IARC)
April Fritz and Company Private 21361 Crestview www.afritz.org Cancer Registry
Associates, LLC Road, Reno, Training &
Nevada 89521, resources
USA
WHO ‐ EMRO Governmental GCC / Eastern www.emro.who.int
Mediterranean
Gulf Center for Organization PO Box 3354 MBC TBA Gulf Cancer
Cancer 03 Riyadh 11211 Incidence
Registration Saudi Arabia
(GCCR) +966‐1‐442‐4286
+966‐1‐442‐4542
Ministry of Governmental GCC www.moh.govt.sa
Health
Healthcare Organization GCC
Organization
(KFSHRC,
KSAMC, KHCF)
Local, Regional NGOs International
and
International
Charities

Access to Cancer Care Medication Inaugural Meeting Report

Access to Cancer Care Medications
Access to Cancer Care Medication
Dr. Nour Obeidat and Dr. Ahmed Saadeddin
*on behalf of the Access to Cancer Care Medication Panel Members

PANEL OBJECTIVES
Describe the challenges of access to cancer medications.
Review the status of pharmaceutical industry in the Arab World
Discuss options on how to obtain these medications.

PANEL MEMBERS
Facilitator
Dr. Nour Obeidat Health Services/Outcomes King Hussein Institute for Jordan
Researcher Biotechnology Center
Dr. Ahmed Saadeddin Consultant, Clinical Oncology Riyadh Military Hospital Saudi Arabia
Dr. Yousef Al Awlah Clinical Pharmacisr KAMC Saudi Arabia
Dr. Nagwa Ibrahim Clinical Pharmacist, Riyadh Military Hospital Saudi Arabia
Oncology/Hematology
Dr. Jamal Eddin Zekri Oncology KFSHRC – Jeddah Saudi Arabia
Neneng Cruz cruzma1@ngha.med.sa +96612520088 Ext 14109 / Fax: +96612520088 Ext 14691
Panel Guest
Name Organization
Barri Blauvelt CEO, Innovara
Haythem Hdeib Roche
Rima Khadra Roche
Hazel Joy R. Alarde Riyadh Military Hospital
Catherine Dela Paz Riyadh Military Hospital
Maryam Omar Riyadh Military Hospital
Erlinda Osmillo KFNGH
Ligaya Batutay KAMC ‐ Riyadh
Rachelle Semana KAMC ‐ Riyadh
Noli Luna Durias KAMC ‐ Riyadh
Sheryll Naval Riyadh Military Hospital
Feryal Said NGHA
Nada Al Faraj NGHA ‐ Dammam
Naeemah Al Innbar NGHA ‐ Dammam
Mohammed Adel El Sayes SCF
Islam El Gasim NCI
Re‐Angilee Guillermo AKMICH
Christine Cequena AKMICH
Cleofe Parungan AKMICH
Claudio Mayura KAMC ‐ Riyadh
Julie Duncil AKMICH

Agnes Emily Sadang AKMICH
Name Organization
Fala Al Khatib Tawam Hospital
Hani Saleh AVH Jerusalem
Fatina Gaeik CPMC Alfiers
Percival Manudoc AKMICH
Doodie Paglingaen Riyadh Military Hospital
Josephine Trinidad Riyadh Military Hospital

ABSTRACT
Background: Several factors impact access to cancer medications. The purpose of this
initial exercise was to highlight, through expert feedback, the major challenges and
strengths of the cancer care delivery system as it relates to drugs, in multiple Arab
countries participating in the Initiative to Improve Cancer Care in the Arab World
(ICCAW), and to provide recommendations to improve access.

Methods: Panel members were asked to list the strengths of the country which
enhance access to medications; the weaknesses or challenges that hinder access to
cancer medications; and recommendations to improve access to cancer medications in
the region.

Results: Strengths reported included, in certain centers, availability of funding,
expertise, continuing education opportunities. Challenges included affordability and
availability of drugs; greater need for expertise in certain centers; lack of a unified
system to ensure equitable and sustainable access; and patient/healthcare manager
attitudinal and behavioral factors that deter use of chemotherapy. An immediate
recommendation to conduct a thorough regional situation analysis was put forth.
Other recommendations centered around enhancing funding for drug therapies;
improving access and appropriate utilization of drugs through institutional and
national drug‐related policies and procedures; strengthening the workforce relevant to
cancer medications access and use; and increasing patient/provider/healthcare
manager education. Recommendations to enhance drug‐related research were also
made.

Conclusions: Various deterrents to effective access to medications will need to be
addressed. As an initial step, a situation analysis to map out specific obstacles and
potential solutions will be necessary.


INTRODUCTION
Drug therapy for curative, palliative, and supportive purposes, plays an integral role in
effective cancer control. However, globally, the equitable, timely and sustainable
provision of high quality cancer medications remains a challenge as providers
endeavor to provide the best possible care, payers attempt to control spending under
imposed budgets and an increasing burden of cancer, while the price of cancer
therapy grows and the landscape for therapy changes with newer innovations
reaching the market. Although, in the long‐run, effective prevention and early
detection efforts may alleviate this challenge, addressing the barriers to accessing
cancer drugs in the meantime is a pressing matter, particularly in a region where late‐
stage presentation of cancer patients remains substantial.

The challenges of drug provision have been well‐documented globally, and it is highly
probable that the conditions faced in the rest of the world are also faced in the Arab
region. Drug costs, insufficient governmental healthcare funding to cover care,
restrictive regulations which hinder drug importation, poor infrastructure needed for
effective drug administration, irrational drug use as a result of limited training or
application of evidence‐based guidelines, bureaucratic policies (particularly as they
relate to opiates availability), and use of counterfeit medications, are among the global
challenges faced in ensuring access to cancer drugs.

In order to address the challenges of accessing cancer therapies, particularly in low to
middle income countries (LMICs), international guidelines on provision of effective
treatments have been developed, and include critical recommendations to develop
healthcare systems that can support equitable and sustainable availability and use of
appropriate treatments. Furthermore, various measures have been taken across
healthcare systems in developed countries also striving to achieve an optimal balance
of treatment [drug] costs and health outcomes across populations. Measures include
performing health technology assessments to evaluate the economic value of drugs,
applying pharmaceutical reimbursement schemes, imposing national budgets to
control spending, regulating drug prices and drug profits, applying patient cost‐sharing
strategies, and implementation of formularies and treatment guidelines. Finally,
additional measures include the use of research (data) systems that support the
conduct of health services research. Such research is indispensable as a means of
monitoring and evaluating access and quality of care in populations so as to identify
and quantify problem areas and track changes and improvements in cancer services.

Although a multitude of strategies to alleviate difficulties in accessing cancer
medications exist, the relevance of these strategies to Arab countries seeking to
improve access to efficient treatments will undoubtedly rely on each country’s
healthcare system [structure and methods of operation]. Thus, any measure, when
discussed in the context of the Arab region, will require adaptation to the local
context. In turn, the local context must be well‐described as it relates to provision of
cancer medications.
In light of the above, an initial step in the ICCAW involved a qualitative situation
analysis to better understand the current status of access to cancer medications in the
various Arab countries participating in the initiative was conducted.


Framework for evaluating access
In order to understand and improve access to cancer treatments, a rigorous diagnosis
of the status of cancer therapy in countries involved in the ICCAW is an essential first
step towards ensuring access to cancer medications. Given that access to medications
(or any healthcare service) is a complex and multi‐faceted process, such a diagnosis
must use a comprehensive framework to cover the various elements and perspectives
that influence access to cancer medications. Framing access in a clear manner will
allow experts to systematically study and compare access issues across countries.

Access is defined as “the timely use of affordable personal health services to achieve
the best possible health outcomes”. Thus, for medications, access is the timely and
affordable use of the appropriate [high quality] and affordable medication to achieve
the best outcome. Access is an umbrella term and covers various elements of the
healthcare continuum. More than one model has been used to depict access. One of
such models (an adaptation of the Andersen‐Aday model) has been used to describe
access to cancer‐related services. Its elements are outlined below:
o Medical care environment
• Health delivery system characteristics, eg:
Resources [Human Resources, financial, structural, medications] in terms
of volume and distribution (eg. chemotherapy clinics’ availability and
distribution across country; availability of high‐quality services and
resources; availability of HR such as oncologists, pharmacists, oncology
nurses)
Organization of system in terms of entry into system; system structure
(private and public hospital/clinic organization, continuity of care,
channels for patients to communicate and navigate system); and system
process (how care is provided)
• Health policies and regulations, eg:
Manpower: policies regarding professional education, credentialing,
training and continuous education, incentives or disincentives as
regulating mechanism
Drugs: financial coverage/insurance; drug approval and technology
assessment policies; drug importation and distribution policies; drug
quality assurance regulations; drug reimbursement policies; drug control
policies; policies determining clinical guideline
development/implementation
Laws or regulations relating to clinical trials
Organization: patient care policies, P&T committees, report cards
(existence of quality of care measures), system supports investigational
drug use and clinical trial participation


o Patient characteristics
• Age, gender, socioeconomic status, health literacy, comorbidities, social
support, culture, KABs (knowledge, attitudes, beliefs) and practices relating to
cancer medications
o Provider characteristics
• Age, gender, specialty, training, competence, perceived constraints, KABs
(knowledge, attitudes, beliefs) and practices relating to prescribing, preparing,
administering or counseling on cancer medications
o Decision/Policy‐makers characteristics
• Competence, perceived constraints, KABs (knowledge, attitudes, beliefs)
o Provider‐patient communication
o Social/cultural environment
o Outcomes of access
• Patient satisfaction, utilization of medications, quality of life and functioning,
patient survival, enrollment in clinical trials

Evaluating and influencing access to cancer medications therefore requires a thorough
and comprehensive situation analysis, particularly when considering the multiple
stakeholders (policy‐makers, drug manufacturers/suppliers/distributors, oncologists
and other healthcare providers such as nurses, pharmacists, and technical support
staff) as well as the potential scope of medication use in cancer control (preventive,
curative, supportive, and palliative).

METHODS
The panel objectives were specifically to describe the challenges of access to cancer
medications; review the status of pharmaceutical industry in the Arab World; and
discuss options on how to obtain cancer medications. Members of the panel were
asked to provide information from their respective countries’ perspectives.
Specifically, panel members were asked to list the strengths of the country which
enhance access to medications; the weaknesses and needs or challenges that hinder
access to cancer medications; and recommendations to improve access to cancer
medications in the region. Finally, members were asked to focus on those
recommendations that could be implemented within a year and identify the potential
resources required to implement them, so as to develop a short‐term action plan for
the region to be implemented within a year after meeting.


Strengths
1. Availability in some countries of highly qualified expertise and centers
practicing evidence‐based medicine.

2. Some major cancer centers have appropriate policies, procedures and activities
in place to assure timely and appropriate access to/use of cancer drugs. These
include establishment of P&T committees, enforcing appropriate drug access
and utilization policies, and hosting related continuous education events to
ensure that staff is well‐informed with regards to cancer therapies.

3. Presence of cancer centers which provide free treatment for patients (e.g.,
public hospitals in some countries in the region).

4. The relative ease, in some centers in the region, of accommodating deficiencies
in cancer medications (for example, arranging for patient transfers when
hospitals cannot provide medications, and addressing drug shortages through
individual drug requests from pharmaceutical companies).

5. Related initiatives underway in some countries to address medications. Such
initiatives indicate a positive move towards addressing inefficiencies in the
healthcare system that deter access to cancer medications. Examples include
establishing national P&T committees in some countries to improve availability
of cancer medications throughout cancer centers, and the planning of National
Cancer Control activities which encompass access to cancer medications.

Challenges
1. No uniform population‐based public system and lacking policies regarding
access to and use of anti‐cancer drugs: as a result, access to effective
treatments may be inconsistent and across certain patient groups or centers in
many countries in the region.

2. Bureaucratic policies on both national and institutional levels in many countries
may deter the timely provision of cancer medications.

3. Geographic and institutional disparities: disparities across private versus public
hospitals, and geographic disparities within and between countries in the
region exist. Thus standardized high‐quality care is not consistently provided.

4. Lack of expertise/resources to respond to problems in providing drugs: lack of
knowledge on part of physicians and healthcare managers regarding the
process of drug procurement, distribution, and utilization limits the extent to
which inefficiencies in the chain of procedures leading to drug delivery at the
patient bed‐side can be addressed.


5. Shortage of qualified staff (physicians, nurses, pharmacists and supportive
staff) compared to the number of cancer patients.

6. Limited access to facilities: although access to certain facilities is possible,
direct access may be limited to specific patient groups (e.g. citizens of the
country only may be eligible for free access; patients capable of paying out of
pocket).

7. Health insurance availability: despite the boom in health insurance and third
party payer schemes in the region, coverage for cancer treatment may not be
purchased at an affordable rate.

8. Cost of some anti‐cancer medications: the global problem of cancer drug costs
applies to Arab countries, where newer and more expensive drugs present a
substantial burden on payers. This inevitably draws restrictions to the
medications’ provision, even in well‐funded hospitals.

9. Misconception (by some providers, decision‐makers) that cancer is a death
sentence. As a result, payers may not be willing to invest in costly but effective
medications for patients.

10. Lack of patient and family education, and detrimental cultural beliefs:
behavioral factors may exist which deter the appropriate use of cancer drugs
even when the latter are available. For example, lack of knowledge about the
value of therapy despite associated toxicities, lack of understanding of the
need for timeliness and compliance during therapy, and the stigma associated
with cancer‐treating centers,

11. No system or policies regarding access to anti‐cancer drugs that applies
uniformly to all public hospitals.

12. Drug availability: market supplies of medications may fluctuate as a result of
several factors, such as poor [drug demand] projection techniques, and
delayed pharmaceutical firm or drug store response to drug requests.

RECOMMENDATIONS
Recognizing the overlapping nature of the various panels covering cancer care
improvement in the ICCAW, the specific recommendations provided by respondent
panel members are included in the table below. The recommendations covered
various aspects of access that, based on expert opinion, will need to be addressed to
improve access to medications. Given the potential broadness of some of the
recommendations, implementing such recommendations in a roll‐out or pilot manner
can begin (e.g. on an institutional level). Furthermore, the overlapping nature of some
of the recommendations can facilitate, to an extent, their simultaneous
implementation.


The following provides a summary of the recommendations. The proceeding table lays
out general action steps that may be taken to implement recommendations.

1. Complete a baseline situation analysis within one year to create a roadmap on
current situation of access to cancer medications in individual countries of the
region.
2. Develop a funding program with governmental, pharmaceutical or other
funding organizations.
3. Establish and execute an ‘exchange of expertise’ program to assist institutions
and countries in developing programs or committees that can enhance access
to cancer medications (eg. P&T committees).
4. Develop regional lobbying liaisons and strategies and begin lobbying, within an
organized campaign, amongst policy makers and professionals for awareness of
specific gaps in the healthcare system as they relate to drug access, and
measures to address gaps in an organized campaign.
5. Analyze and reform where necessary current health policies and regulations to
comprehensively address access to cancer care and medications. Given the
various policies that can govern drug access, this recommendation is broad in
scope, potentially covering the following areas: national formulary policies,
health insurance policies, drug pricing policies, policies pertaining to ensuring
high‐quality generic drugs, policies regulating medication safety and
pharmacovigilance development/improvement, policies controlling
pharmaceutical promotions, clinical trials and compassionate drug use laws
and regulations, and the availability of regulations regarding treatment.
6. Conduct KAP (knowledge, attitudes and practices) surveys in patients and
healthcare professionals in order to better understand behavioral variables
influencing access to cancer drugs.
7. Enhance the human resource capacity required to facilitate access to
medications (medical and research staff).
• Develop a strong and comprehensive workforce by training relevant
professionals (clinical pharmacists, physicians, researchers) both
technically and from a managerial/policy/advocacy standpoint in
various areas (e.g. clinical, health economics, policy research).
8. Develop a user‐friendly information system similar in structure and purpose to
tumor registries which can help identify progress and short‐comings of
medication use and access in the Arab region.
9. Produce population‐based medication utilization patterns and outcomes
studies through available health information systems in major centers, and use
these HISs as examples to develop other systems in other cancer hospitals
missing such a component.


Table 1: Recommendations
Objectives Action Steps Indicators (structure, process or
outcome)
1. Complete a baseline situation a. Formulate group – who will do this and • Team assembled.
analysis within one year to create how (include an organization to • Survey and survey protocol developed.
a roadmap on current situation of endorse, eg. WHO, UICC) • Validated instruments to diagnose
access to cancer medications in b. Develop or modify survey tool to problems, within MENA medicines
individual countries of the region. systematically capture data across markets and government institutions, in
An alternative mechanism countries. E.g. Design Standardized regulating and financing medicine supply.
towards this analysis is through a assessment tool for collecting data on • Funding party identified and ascertained.
cancer‐specific MeTA (medicines medicine prices, availability, • Execution initiated.
transparency alliance) initiative affordability, access to medicine in • Recommendations and report produced.
to spearhead the evaluation and population across socioeconomic strata, • At least one policy change or intervention
transformation of access to key process for regulating and to address a problem(s) identified through
cancer medications. managing medicines supply chains stakeholder dialogue
c. Agree on key elements to capture
(focused survey)
d. Agree on target respondents
e. Develop protocol for survey procedure
f. Seek funding
g. Pilot and subsequently refine protocol
as necessary
h. Implementation
i. Reporting of results
j. Revisit panel short‐, intermediate‐ and
long‐term objectives
k. Provide evidence‐informed
recommendations
2. Improve funding for cancer a. Negotiate reasonable deals with drug • At least one PAP developed.
medications. industry. One example is refund or • At least one health insurance plan
proportional refund if an expensive including cancer coverage, made available.
drug does not benefit the patient. This
can be started as a pilot in a single
institution with a pharmaceutical
partner, and spread to other
institutions if successful.
b. Negotiate with health insurance plans
and sponsors of plans, potential
insurance schemes for coverage for
cancer therapy. Employers purchasing
insurance plans may initiate this step.
c. Develop a body that evaluates the value
of medical technologies. This body will
appraise drug cost and efficacy and
draw recommendations regarding value
and use, and will be more effective if
developed on a national scale so that
hospitals will not have to go through
the same evaluation process again. One
example of such a body is NICE.
3. Establish and execute an a. Identify willing experts and institutions • Expert list produced.
‘exchange of expertise’ program able to participate by ‘loaning’ experts. • Program descriptions generated, with
to assist institutions and b. Identify topics to target in educational specific objectives, plan and outcomes.
countries in developing programs collaborations. • ?MoUs between loaning and recipient
or committees that can enhance c. Identify centers with specific needs that institutions developed.


outcome)
access to cancer medications (eg. can be addressed through educational • Atleast one educational exchange
P&T committees) collaboration. conducted.
d. Develop descriptions for one to two
short‐course programs or other form of
expert‐exchange program.
4. Develop regional lobbying a. Identify umbrella of national and • Expert group identified.
liaisons and strategies and begin regional experts • Executive plan for lobbying initiative
lobbying, within an organized (physicians/nurses/pharmacists, policy‐ developed by experts.
campaign, amongst policy makers makers, healthcare managers, • Structure and content of awareness
and professionals for awareness researchers) that can advise and sessions developed.
of specific gaps in the healthcare partake in lobbying activities. • Change in number or scope of activities of
system as they relate to drug b. Develop executive plan with desired target groups.
access, and measures to address objectives and strategies. • Annual changes in amount of public fund
gaps in an organized campaign c. Secure funding for lobbying activities. for oncology and caner medication.
d. Pilot activities in one institution or one • Annual change in purchases of cancer
country by conducting awareness medications.
sessions targeting CSOs, professional • Sustained policy or system change
oncology societies, media, healthcare conducive to better access to cancer
planners, managers and decision medications as a result of lobbying
makers in governmental and non‐ activities.
governmental sectors.
• Training or awareness‐raising
workshops on medicine
pricing, quality, availability;
health technology
assessments; drug policies;
research and its importance;
advocacy and its role in access
to medication.
• Conduct pre‐ and post‐session
evaluation surveys
5. Analyze and reform where a. Identify health policies currently in • Document produced detailing process for
necessary current health policies place and propose necessary reforms as policy reform for site (country/institution)
and regulations that well as additions required for high‐ • Atleast one new or modified policy
comprehensively addresses quality drug procurement, storage, implementation plan developed
access to cancer care and distribution, and utilization in a
medications. sustainable and equitable manner.
b. Identify mechanism for generating,
approving and implementing policies at
an institutional or national level.
c. Conduct necessary policy research (e.g.
KOL interviews) to support evidence‐
informed policy reform
6. Conduct KAP (knowledge, a. Formulate research team per country • Research team assembled
attitudes and practices) surveys participating • Survey produced and approved regionally
in patients and healthcare b. Develop survey design and protocol to • Implementation initiated
professionals in order to better apply across all countries • Results‐based recommendations produced
understand behavioral variables c. Seek funding and potentially
influencing access to cancer outsourcing
drugs. d. Obtain appropriate approval from
ethics committees
e. Implementation
f. Results analysis and country‐specific


outcome)
reporting of recommendations for
future programs based on observed
KAPs
7. Enhance the human resource a. Develop Fellowship Programs in the • Number of submitted proposals for
capacity (medical and research fields of clinical pharmacy in all programs
staff). oncology/hematology related sub‐ • Number of accredited fellowship programs
specialties; medical oncology; oncology • Number of developed training courses on
nursing issues such as health policies, health
b. Submit the programs for accreditation insurance schemes, medicine pricing and
from Arab Board and local Health drug regulation.
Specialty Boards • Number of trainees enrolled in programs
c. Establish training programs in different or courses.
major hospitals • Feedback from trainees.
• Programs should cover both clinical
topics as well as
managerial/policy/advocacy topics
(e.g. health economics, health
technology assessments, policy
research, health finance).
d. Establish affiliation with advanced
centers in North America and Europe
8. User‐friendly information a. Develop proposal to establish a user‐ • Team established
system to identify progress and friendly, simple and implementable • System structure approved
short‐comings of medication use population‐based informatics system, • Buy‐in to implement systems secured in
and access in the Arab region. or to piggyback on currently existing atleast one major center per country
Current systems may currently registry or other data‐collection • Live data‐collection initiated
exist in some countries which can systems. • Reports/studies on medication use
be used as an example to follow. b. Secure funding or support to develop patterns and outcomes produced
• Conduct medication informatics system.
utilization patterns and c. Secure buy‐in from agencies or cancer
outcomes studies institutions that can participate in data
through health collection. E.g. identify registry‐
information systems containing hospitals with the capacity
to collect further treatment details and
obtain buy‐in to add treatment
information.
d. Establish a multi‐disciplinary team of
clinicians and health informatics
specialists to identify elements that will
be needed in the system, and to
oversee system development.
e. Begin system implementation:
• Pilot in major institutions and roll‐
out if necessary

Ensure that adequate access to cancer medications for cancer patients is thoroughly
studied,
lobbied and applied based upon scientific evidence.

Action steps:
v. Complete a baseline situational analysis on access to cancer
medications.
vi. Secure sufficient funding for cancer drug therapies.
vii. Ensure availability of health policies that address access to cancer
medications.
viii. Establish and execute regional and international ‘exchange of
expertise’ programs.

There was consensus with regards to an achievable one‐year goal to be selected as
an immediate recommendation: conducting a situation analysis to determine the
major potentially changeable deterrents to achieving access to cancer medications in
multiple countries within the region.
A methodologically more rigorous and systematically conducted situation analysis of
access to cancer medications can be conducted on a country‐level for each
participating country, in order to identify existing systems, mechanisms and
resources behind the process of accessing cancer drugs. This is particularly important
as well‐collected baseline data (through situation analyses) will be critical in future
planning for improving access to cancer medications.
The one‐year action plan is summarized below.
1. Formulate group – who will do this and how (include an organization to endorse,
eg. WHO, UICC)
2. Develop or modify survey tool to systematically capture data across countries
3. Agree on key elements to capture (focused survey) and audience to target
4. Develop protocol for survey procedure
5. Seek funding
6. Pilot and subsequently refine protocol as necessary
7. Implementation
8. Reporting
9. Revisit panel short‐, intermediate‐ and long‐term objective
10. Provide evidence‐informed recommendations
11. Manuscript development and publication


Table 2. 12 Month Action Plan

Action Steps Responsible Required Other Required Timeline

Person / Entity Funding / Resources
Source
Formulate group – who will do this and how Participating panel Adequate Month 1
(include an organization to endorse, eg. WHO, members and external secretarial and to 2
UICC) consultants legal support
throughout;
outsourcing is
possible
Develop or modify survey tool to systematically Participating panel Month 1
capture data across countries members and external to 2
consultants
Agree on key elements to capture, audience to Participating panel Month 1
target members and external to 2
consultants
Develop protocol for survey procedure Participating panel Month 1
members to 2
Seek funding Participating panel Month 3
members
Pilot and subsequently refine protocol as Executive team and Month 4
necessary participating panel
members
Implementation Executive team Month 4
to 9
Reporting Executive team and Month 10
participating panel to 12
members
Revisit panel short‐, intermediate‐ and long‐term Participating panel Month 12
objectives members and external
consultants
Provide evidence‐informed recommendations Participating panel Month 12
members and external
consultants
Process for manuscript development & publication Participating panel Month 12
members


AVAILABLE RESOURCES

Type Affiliation
Contact Information
Individual, Governmenta Specific areas of
Entity Name Phones and faxes,
Institution, l, Non‐ Location expertise and
email website
company, governmental / Address interest
organizatio , private,
n,
university
Nour Obeidat, King Individual, Private Jordan Nobeidat@khibc.jo Health
Hussein Institute for institution +9626‐5511003 Services/Health
Biotechnology and Outcomes Research
Cancer
Saudi Clinical Pharmacy,
Individual, Riyadh Military Nag_ibrahim@hotmail.com
Nagwa Ibrahim Arabia Oncology/Hematolo
institution Hospital +966‐1‐4777714 Ext: 28116
gy
Ahmed Saadeddin Riyadh Military Saudi Aldeen60@yahoo.com Clinical Oncology
Hospital Arabia
Yousef Al Awlah KAMC Saudi awlahy@ngha.med.sa Clinical Pharmacy
Arabia
Jamal Eddin Zekri Oncology
Falah Al‐Khatib falkhatib@gulficc.ae Oncology
Jean‐Jacques Zabrowsky Jjzambrowski@wanadoo.fr
Barri Blauvelt Barri.blauvelt@innovara.co
m

CONCLUSIONS
Access to cancer medications is multi‐faceted, being influenced by various
environmental, system‐level, provider‐level and patient‐level factors. Furthermore,
cancer as a disease, and oncology products in general, introduce additional factors
that require consideration when evaluating access in the region (for example,
burden of late stages, costs of new therapies, expertise required to oversee
provision and administration of therapies).
It is evident that challenges exist which impact the timely and equitable access to
best care in the region. Several of the listed challenges likely apply to other countries
in the region, and require a well‐planned and comprehensive approach to correct.
The information provided thus far presents a critical initial step in broadly identifying
potential interventions to improve access to cancer medications. However, further
and more detailed situation analyses of the healthcare system within each Arab
country, and throughout the region, will be needed. Such analyses will provide the
necessary evidence regarding gaps in care and driving factors behind such gaps, and
will provide the basis for proposing specific and country‐relevant solutions to
address the gaps.

REFERENCES

1. World Cancer Report 2008. Eds Peter Boyle and Bernard Levin. Accessed
6/3/2010 from http://www.iarc.fr/en/publications/pdfs‐
online/wcr/2008/index.php
2. Brown MP, Buckley MF, Rudzki Z, et al. Why we will need to learn new skills to
control cancer. Intern Med J 2007; 37(3):201‐4.
3. Access to cancer drugs. International Union Against Cancer (UICC) position
paper, revision 2008/2009. Accessed 7/3/2010 from
http://www.uicc.org/templates/uicc/pdf/special%20reports/access_to_cancer
_drugs_uicc.pdf
4. Cancer control: knowledge into action: WHO guide for effective programs,
diagnosis and treatment (module 4). World Health Organization. Accessed
6/3/2010 from http://www.who.int/cancer/modules/FINAL_Module_4.pdf
5. Drummond MF, Mason AR. European perspective on the costs and cost‐
effectiveness of cancer therapies. J Clin Oncol 2007; 25(2):191‐5.
6. Stafinski T, McCabe C, Menon D.Funding the Unfundable: Mechanisms for
Managing Uncertainty in Decisions on the Introduction of New and Innovative
Technologies into Healthcare Systems. Pharmacoeconomics 2010; 28 (2): 113‐
142.
7. Lipscomb J, Donaldson M, Hiatt R. Cancer Outcomes Research and the Arenas
of Application. J Natl Cancer Inst Monographs, October 1, 2004; 2004(33): 1‐7.
8. Millman ME. Access to health care in America. Washington, DC: National
Academy Press, 1993.
9. Aday L and Andersen R. A Framework for the Study of Access to Medical Care.
Health Services Research 1974; 9(3): 208‐20.
10. Mandelblatt J, Yabroff KR, Kerner J. 1998. Access to quality cancer care:
Evaluating and ensuring equitable services, quality of life and survival. National
Cancer Policy Board commissioned paper.
11. Mandelblatt J, Yabroff KR, Kerner J. Equitable Access to Cancer Services: A
Review of Barriers to Quality Care. Cancer 1999; 86: 2378‐90.

Access to Palliative Care Inaugural Meeting Report


Dr. Omar Shamieh, Dr. Rafa Al Shehri and Dr. Mohammed El Foudeh
*on behalf of the Access to Palliative Care Panel Members

PANEL OBJECTIVES
a. Assess the current situation of Palliative Care in the Arab World.
b. Analyze challenges and needs for Palliative Care in the Arab world.
c. Present recommendations and strategic steps to improve Palliative Care.

ACCESS TO PALLIATIVE CARE PANEL MEMBERS
Facilitator
Dr. Omar Shamieh Consultant, Palliative Care King Abdulaziz Medical Saudi Arabia
City
Dr. Rafa Al Shehri Section Head, Palliative Care King Abdulaziz Medical Saudi Arabia
Division, Dept of Oncology City
Dr. Mahmoud El Foudeh Consultant, Oncology & Palliative King Faisal Specialist Saudi Arabia
Care Medicine Hospital and Research
Center
International Experts
Dr. Mhoira E F Leng Medical Director Cairdeas International Uganda/Scotland
Palliative Care Trust
Dr. Frank Ferris Director, International Institute for Palliative San Diego, CA
Programs Medicine at San Diego
Hospice
Dr. Mohammed Al Shaqi Consultant, Palliative Care Riyadh Military Hospital Saudi Arabia
Dr. Hasan Abbas Consultant, Pal Care King Hussein Cancer Center Jordan
Dr. Mohammad Shtayat Consultant, Pal Care Al‐Basheer Hospital Jordan

Dr. Mohammad Hidayatullah Consultant, Pal Care Tawam Hospital UAE
Dr. Azza Hassan Consultant, Hamad Medical Center Doha
Palliative Care
Dr. Nahla Gafar Radiation and Isotope Center Sudan
Dr. Khaled Al Saleh Head, Radiation Oncology Kuwait Cancer Control Center Kuwait
Department Ministry of Health
Head of Pal Committee
Dr. Fouad Sabatin Director AVH Cancer Care Center Palestine
Dr. Hany Abdel Rahman Sayed Consultant Pediatric Oncology National Cancer Institute / Egypt
Cairo University
Prof. Abdelatif Benider Member de l’Association Lalla Ibn Rochdd Hospital Morocco
Salma / Professor Head of
RAdiotherapy Oncology
Department


Dr. Amani Babgi Associate Dean Academic Affairs Saudi Arabia
King Saud Bin Abdulaziz
University for Health Sciences
Ms. Sue Volker Operations Administrator, Dept King Abdulaziz Medical City Saudi Arabia

of Oncology
Dr. Yousef Al Awlah Clinical Pharmacist, King Abdulaziz Medical City Saudi Arabia
Pharmaceutical Care Dept.
Neneng Cruz Cruzma1@ngha.med.sa +96612520088 Ext 14109 / Fax: +96612520088 Ext 14691
Panel Guest
Name Organization
Ahmad Tassi King Abbdulaziz Medical City
Dr. Mohammad Tarawneh Ministry of Health, Jordan
Dr. Ibtihal Fadhil WHO/EMRO
Dr. Hayfa Watban King Abdulaziz Medical City
Janet Vaughan King Abdulaziz Medical City
Mohammad Al Harbi King Abdulaziz Medical City
Deniela Mengato European Arab School of Oncology
Roberta Ventura European Arab School of Oncology
Cecilia Sepulueda World Health Organization
Manal Zaidan HMC‐Al Amal Hospital
Nouf Al‐Dhwayan King Fahad Specialist Hospital
Hanadi Attiyah King Fahad Specialist Hospital


ABSTRACT

Background

Palliative Care is an important and integrative component of comprehensive cancer
care and any effective cancer control program 3,16. Around 60 – 80% of cancer
patient present late to health care system in the Arab countries, making palliative
care is the only option for management. Palliative care is aimed to relieve patients
and families suffering caused by cancer and improved their quality of life.4

Palliative care is in its early stages of development in the Arab Countries. Level of
provision is variable and faced with many challenges and barriers1 It was essential to
analyze the current situation of Palliative care in the Arab countries, gaps and
challenges and areas for improvement in order to facilitate a comprehensive
management for cancer patients.

Methods

A panel of 18 multidisciplinary palliative care experts from 13 Arab countries was
formed with 3 major objectives mentioned earlier. A brief situational analysis, SWOT
analysis and recommendation form was distributed to all members, completed form
were collected and results were analyzed and discussed during a panel meeting. The
panel reached a consensus on a 12 month project and for objectives for the next 10
years (2020).

Results

Palliative care is in its early stage of evolution in the Arab countries countries and
specific detailed data multiple data is missing and hard to get from many countries.
Palliative care provision is scarce and variable among Arab countries ranging from no
service at all to availability of comprehensive palliative care services in some cancer
centers.5 Palliative care development and provision is encountered by many
challenges and barriers. The challenges are almost universal the broad categories
are focused around shortage of manpower, lack of education and training,
availability and access to opioids, lack of national policies and support to palliative
care.

Few centers reported comprehensive palliative care provision, availability of many
opioids, increasing number of palliative care experts and starting to teach palliative
care for undergraduate student and post graduate residents 6,7

All members reported the need for capacity building manpowered human resource
development and improvement in opioids policies.


Conclusion

This initiative was a very successful mile stone for palliative care development in the
Arab countries. It highlighted and emphasized the need for integrating palliative
care across all stages of cancer care development and delivery.

The brief situational analysis highlighted the need for a wider spectrum data and
mapping of available resources for cancer and palliative Care.

The SWOT analysis identified major service development and achievement in regard
to service provision, opioid availability and capacity building. Yet faced with many
challenges and barriers in relation to policy, human resource, funding and access to
opioids and facilities, home health care, and pediatrics palliative care and inequity of
service provision.

The next 12 month project is aimed to map demographics the available resources
and identify gaps and areas which needs further improvement.

The recommendations were all about the improvement of current situation and over
coming challenges.

For a country specific strategy for palliative care to be successful this conference
further highlights the importance of improving cardinal elements, policy, opioids,
services and education.11

It is also important to develop regional standards for training, advocacy services,
policies and research.

The panel objective for the next 2020 was aimed for integrating palliative care for all
cancer patients addressing multiple elements highlighted by WHO 3,16 and major
international organization.7, 11

This panel will serve as venue for sharing and exchanging of experience, networking,
multilayer of collaboration and advocacy for further development of palliative care
across the Arab world.

It is very crucial to understand each country specific infrastructure and resources and
identify the best model of delivering palliative care at this stage


INTRODUCTION

Magnitude of the Problem

Cancer incidence is increasing across the world. This increase is also
evident in the Arab countries. This might be in part due to many
environmental factors and increasing life expectancy.

Around 60 – 80% of cancer patients present late to health care system for
many factors like, education, poor access, poor resources and multiple
socio economic factors.2

à Palliative care is an approach to alleviate suffering for patients diagnosed
with a terminal illness like cancer (WHO Definition) 4

à Patients with cancer pass through multi facets of suffering, including of
physical, psychosocial and spiritual elements which all can be addressed
by palliative care utilizing interdisciplinary care teams.

à Access to Palliative care is regarded as a human right for all patients
diagnosed with a terminal illness like cancer. In similar way that humans
have rights to food, clean water and shelter. 17

à Palliative care is an integral part for comprehensive cancer care and for
any effective cancer control program. For the above reasons it is critical
to address palliative care for the future development of cancer care in the
Arab countries. 14,18

Palliative Care in Arab Countries

à Palliative care provision in Arab countries started as early as 1992 in King
Faisal Specialty Hospital in Riyadh alone. It was until 2004‐2005 new
palliative care services emerged in different cancer care centers across
many other countries and now at least 14 out of 22 Arab countries are
identified to have one or more Palliative care services. 5,10

à There is a wide diversity in the Arab countries, health care, infrastructure,
coverage, resources, policies, trained manpower and in particular the
availability and access to cancer treatment itself.5


à Opioids are significantly under used across Arab countries. It is estimated
that less than 3% of the needed opioids are used to treat patients at their
end of life.8,9 Many factors are responsible for opioids under use and
utilization like unavailability of many opioids forms, strict policies, poor
access and opioid phobia.12

Barriers to Palliative Care and Services

à There are many barriers and challenges to initiation and implementation
of palliative care services. These challenges are focused around major
elements; negative care provider attitude, knowledge, availability of
trained palliative care experts, opioids availability, governmental support,
policies and funding.13

à It is very obvious that there is wide gap in what is ideal what resources
are available and what can be achieved in different Arab countries.


a. Panel Formation

à 13 countries of all 22 Arab Countries identified to have at least one
palliative care service or one palliative care expert or interested physician
or a nurse in establishing palliative care service
à 18 panel members were invited agreed to participate in the panel
à 14 physicians, 3 nurses, and 1 clinical pharmacist
à Initial assessment form was distributed to all members via email
à 13 members returned their completed forms.
à All panel members were invited to attend a panel discussion between
March 23‐25 to agree on recommendations and strategic steps and to
reach a consensus for immediate and long term collaborative projects.

b. Initial Assessment included the following:

à Brief situational analysis
a. Country demographics
b. Available policies and services
c. Opioids availability and consumption
à Challenges and strengths
à Proposed one year project
à General recommendations

c. Data Synthesis

The data collected from all members were compiled verified by members
and a SWOT Analysis was constructed to include strengths, weaknesses,
opportunities and threats

d. Panel meeting

à The panel members met on March 24th 2010 to discuss their
recommendations, decide on 12 month objective and the 2020 strategic
plan
à After the meeting the findings were presented in a plenary session


SWOT ANALYSIS

Strengths
à Few countries indicated the presence of some sort of governmental
support to palliative care
à Comprehensive palliative care services are available in countries like
Saudi Arabia and Jordan.
à Increasing number of palliative care specialists across the Arab countries.
à Hospital based palliative care units are available in Saudi Arabia, Jordan,
Qatar and UAE and recently Sudan.
à Inter‐disciplinary teams are available in some centers.
à Home Health Care services are available in Saudi Arabia, Jordan, Qatar,
UAE and Morocco.
à Availability of opioids in many forms in many countries i.e. Saudi Arabia,
Qatar and Jordan.
à Extended opioids prescriptions up to 4 months in Lebanon and 1 month in
Saudi Arabia.
à Post graduate palliative care rotations are available for residents and
fellows in Saudi Arabia, Qatar and Jordan.
à Integrated palliative care curriculum in College of Medicine at King
Abdulaziz University of Health Sciences in Riyadh, Saudi Arabia.
à Palliative care research activities reported in Saudi Arabia and Qatar.
à Acceptance of palliative care concept by medical and general community.
à Approval of comprehensive stand alone Palliative Care Center and
Palliative Care Education Center at King Abdulaziz Medical City in Riyadh,
Saudi Arabia.
à Opioids and essential drugs are provided free of charge to patients.

Challenges/Weaknesses
à Lack of support of policy makers for implementation of National Palliative
Care Program or policies
à Fragmented health care systems
à Lack of Home Care services in many countries, even if available in some
countries it is limited in large cities
à Lack of experienced healthcare staff in the field of palliative care including
physician, nurses and other health care providers

à Lack of funding to support many palliative care activities related to
program development, education, medications and services.
à Lack of pharmaceutical industry support to palliative care
à Lack of pediatrics palliative care services and experienced staff
à Scarce availability of opioids in many countries at large and in other
countries it is limited to large cancer centers, and large cities
à Geographical inequity of services and opioids distribution
à Palliative care is still viewed as less prestigious specialty
à Lack of nurses trained in palliative care across all Arab World
à Lack of National Palliative Care Program across all Arab countries, if
present not implemented
à Lack of Palliative Care provision in private centers
à No “Do Not Resuscitate (DNR)” policy exists in many countries
à Poor information disclosure to patient and families by their health care
providers
à Cancer patients present at late stage to health care and late referral to
Palliative Care
à Lack of Palliative Care training programs and curriculum for
undergraduate, post graduate medical and nursing colleges and
universities
à Lack of chronic and long term cancer care facilities and infrastructure
à Low number of pain clinics, pain specialties, especially interventional pain
specialists in many countries
à Many cultural barriers exist and misconception towards palliative care
and opioids use
à Limited research activities across all countries
à Misinterpretation of religious practices pertaining to palliative care and
opioid use
à Lack of palliative care guidelines, standards and quality assurance
program
à Lack of national and local palliative care associations
à No support, services or staff for palliative care in primary care and non
cancer health care specialties.
à Lack of palliative chronic and long term care infrastructure for terminal
non‐cancer patients.
à The referral to palliative care team is usually late.

Summary of Challenges
It is not a surprise to find similar challenges overlaps across many Arab
countries. Most of these challenges can be grouped in the following
categories:

1. Lack of knowledge, negative attitude and cultural barriers
2. Lack of national and institutional policies
3. Scarce service provision including
a. Institutional and
b. Community services
4. Manpower and human resources
a. Physicians, nurses
b. Interdisciplinary staff
5. Training and Education
a. Undergraduate or postgraduate
6. Opioids
a. Opioid phobia, policies, availability, distribution
7. Lack of standards and guidelines across all domains of Palliative Care
8. Scarce research activities
9. Funding difficulties

Opportunities
à Presence of comprehensive palliative care centers/services which can
serve as Centers of Excellence for palliative care referral, education and
research i.e. King Abdulaziz Medical City, King Hussein Cancer Center, and
King Faisal Speciality Hospital and Research centers, and King Fahad
Specialist Hospital (KFSHD) in Saudi Arabia and King Husain Cancer Center
in Jordan.
à Established palliative care capacity building programs and educational
center and subspecialty fellowship programs in some countries.
à Increase number of Cancer Care Centers establishing palliative care
services, leading to increase service provision.
à Increase palliative care capacity building activities across the Arab region.
à The initiative serves as a richfull source for further experience exchange
and collaboration among all Arab countries.

Threats
à Political boundaries and challenges
à Lack of funding
à Failure of implementing a wider country specific cancer control programs
à Lack of high political and policy makers support


PRE‐CONFERENCE GENERAL RECOMMENDATIONS
Objectives Action Steps Responsibilities Indicators Comments

Initiate palliative care 1. Develop teams of experts to 1. # of teams
services around the assess the needs and capacity to developed
country start programs/ services around 2. # of healthcare
the country. professionals
2. Train healthcare professionals to trained.
continue these services and 3. # of services
mentor them through the process developed and
for a period of time until becoming mentored by the
a center of excellence for other teams
organizations. 4. Percentage of
3. Develop general competencies to adherence with the
be practiced by all healthcare general
professionals who are not palliative competencies
care specialists. developed.
1. Monitor the number of referrals 5. # of referrals of
oncology/ non oncology related oncology/ non
cases. Integrate a comprehensive oncology cases
model by either initiating home Percentage of
health care services, or collaborate satisfaction with the
with existing ones. services developed
Percentage of
services’ integration/
comprehensive model
achievements.
Increase health care 1. Conduct lectures in major hospitals Major hospitals and 1. No. of physicians & Palliative care
professionals in Amman and different provinces palliative care services. health care provider physician and team
awareness about in Jordan Include pain received education shall be involved and
importance of opioids management lectures in the 2. Using bed side organize the
in cancer pain and hospitals in-service and continuing teaching models workshops
other terminal education programs for health care Number of workshop
illnesses professionals delivered over at least
one week
Palliative care 1. Communicate with major 1. National Palliative Care 1. No. of Faculty attend Time frame
introduced in the universities in the country Committee training
curriculum of both 2. Training courses to increase 2. MOH 2. No. of workshops
undergraduate and awareness of faculty of medical, 3.
postgraduate levels nursing, social , and pharmacy
for physicians, schoolsCreate a national
nurses, social curriculum for palliative care
workers, tailored to society and tradition of
psychologists, and the country
pharmacists
Development of Proposal to be submitted to the Approval and

national cancer governmental bodies. implementation of such
program with programs.
palliative care as a
part of continuum of
cancer care.
Ensuring drug 1. Initiate a list of drugs need in 1. Consensus on a

availability in palliative care and share with unified list of drugs
institutions, and at institutions. 2. # of policies and
homes throughout the 2. Develop policies and protocols of protocols developed
country with control control, dispensing, administration and implemented.
policies development. and diversion to be standardized 3. Percentage of opioid
and used around the country. consumption for
Develop a database for opioid palliative care
consumption for palliative care purposes per year
patients around the country. and per institution
Mortality rate
monitoring.


Create a palliative 1. Develop more fellowships 1. # of programs/
care manpower force programs for physicians and diplomas developed.
from different diplomas for nurses and social 2. # of programs/
disciplines around the workers. diplomas accredited.
country. 2. Have these programs and 3. # of training centers
diplomas accredited by SCHS and selected.
Arab accreditation bodies 4. # of healthcare
3. Select training centers for professionals
implementation enrolled.5.# of
4. Evaluate the impact of these healthcare
programs and diplomas in professionals
improving palliative care service graduated and
accessibility. practiced.# of
services initiated
around the country
Develop a committee 1. Checkout interested organizations 1. # of organizations

from all representing countrywide. participating
institutions to work on 2. Choose or nominate covering
developing representatives from each countrywide
educational programs organization 2. 2.# of programs
for different 3. Develop working groups by developed and
disciplines in palliative discipline to work on educational accredited# of
care program plans programs
4. Develop needs assessment on implemented
educational programs to find out 3. # of programs
what exist. evaluated
5. Develop consensus on proposed 4. # of programs
educational programs per disseminated
discipline
6. Start implementation process in
these organizations or select a
center in each city to implement
7. Evaluate the impact of
implementing the educational
program Disseminate the
committee plans and findings
around the country.
Develop a national 1. Develop a database work group 1. # of participating

database system for among organizations organizations
palliative care 2. Design a standardized template/ 2. # of database
standardized in all program to be used in all template developed
represented participating organizations /specialty
institutions Collaborate in unifying access in Percentage of
which EMR to be viewed by all Utilization of unified
organizations EMR by
organizations
Create palliative care 1. Create professional development 1. # of professional

resources and plans development
facilities for all 2. Develop center of excellence in programs created
healthcare palliative care research and and utilized
professionals education Encourage national and 2. # of researches
international palliative care conducted
conferences development, 3. # of articles
participation/ representations published
4. # of national
conferences
development,
participation/
representation# of
international
conferences
participation/
representation


To receive 1. Initiate Strategic Plan: Draft 1. Mission, vision,
governmental mission, vision, values statements values statements
approval for National and objectives for a National and objectives
Palliative Care Palliative Care Program completed by Day 30
Program 2. Include clinical, educational, of timeline
research and quality improvement 2. Draft outline
components, across primary, completed by Day 60
secondary and tertiary settings. of timeline
3. Produce a draft outline of proposal, 3. At least 14 Steering
with timeline, to serve as a guide Committee invitees
for ensuing activities have accepted
4. Identify key stakeholders, invitation.
including regional representatives, 4. First Steering
to serve as members of a Steering Committee meeting
Committee held by Day 120 of
5. Hold an initial and subsequent timeline
Committee meetings, as 5. Submit Proposal to
necessary, to complete the Ministry of Health by
proposal Day 250
Finalize and submit the proposal to the
Ministry of Health
To train highly 1. Develop Fellowship Programs in 1. Number of submitted
specialized and the fields of Medical Oncology, proposals
skilled physicians in Hematology, Pediatric Hematology 2. Number of accredited
all oncology related Oncology, Gynecology Oncology, fellowship programs
subspecialties Radiation Oncology, etc. 3. Number of trainees
2. Submit the programs for enrolled in this
accreditation from Arab Board and program
local Health Specialty Boards
3. Establish training programs in
different major hospitals
Establish affiliation with advanced
centers in North America and Europe
To increase the 1. Collaborate with leaders in Saudi
number of trained, Nursing Education to develop a
qualified nurses Palliative Care Nursing Education
providing specialist Strategic Plan
palliative nursing care 2. Identify educational models
culturally and socially acceptable
in the Kingdom
3. Develop educational modules for
inclusion in College of Nursing
curricula across the Kingdom
Collaborate with US and UK academic
centers to provide educational
opportunities for Master’s and Doctoral
level Palliative Care education, both in-
Kingdom and abroad
To increase the 1. Collaborate with leaders in Saudi
number of trained, Education facilities to develop a
qualified Social Palliative Care Education Strategic
Workers, Dieticians, Plan for each discipline
Pharmacists and 2. Identify educational models
other associated culturally and socially acceptable
disciplines providing in the Kingdom
specialist palliative 3. Develop educational modules for
care inclusion in relevant College
curricula across the Kingdom
4. Collaborate with US and UK
academic centers to provide
educational opportunities for
Master’s and Doctoral level
Palliative Care education, both in-
Kingdom and abroad

PANEL DISCUSSION/MEETING OUTCOME (MARCH 24, 2010)

General Recommendations

The following recommendations served as a framework for short and long
term objectives:

à Establish Arab World Palliative Care network for exchange of experience
and collaboration at all levels.
à Allocations of funds
• Palliative care services
• Education & training
• Research
à Establish comprehensive national palliative care plan for each country
à Advocacy Æ Increase awareness of the importance of palliative care
among policy makers, health care executives, ministers philanthropists
and the general public
à Develop general consensus for ethical, legal and religious practices
pertaining to palliative care
à Palliative care training and education
• Undergraduate medical and nursing schools
• All postgraduate residency training program
• All Health care professionals
à Availability of opioids and essential medications, reviewing the current
policies, improving access and maintaining accessibility. (19, 20)
à To make palliative care an integral component of all cancer conferences
and symposia
à Home Health Care should be an available option for all cancer patients
à Palliative Care should be available for all age groups

Points of Discussion

The panel was divided into 5 groups to discuss the following elements to
have consensus on the short term objectives:

à Education and Training and Research
à Situational Analysis, Data and Research
à Advocacy and Policies
à Access to opioids and essential medications
à Models of Care i.e. Home Health Care, Pediatric Palliative Care


2020 STRATEGIC OBJECTIVES
Promote the integration of comprehensive palliative care for all cancer patients
throughout the Arab World.

Action Steps:
ix. Increase palliative care awareness through advocacy and networking.
x. Identify gaps, needs and available resources for palliative care throughout
the Arab World.
xi. Promote the development of country‐specific palliative care strategic
plan.
xii. Promote the adaptation and integration of palliative care curricula in the
existing curricula for all health care providers, at all levels.
xiii. Establish palliative care training programs from basic to specialty levels.
xiv. Promote the availability of and access to essential opioids and other
palliative medications for all cancer patients.
xv. Promote the development of palliative care services at all levels of care,
including community services, for all age groups.
xvi. Establish, implement and evaluate palliative care standards across
advocacy, service provision, education, training, monitoring and research.

12 MONTHS PROJECT
Identify gaps in palliative care services and resources provision for the cancer
patient population in the Arab World.

d. Initiate Arab World mapping of available palliative care services; facilities;
manpower; medical, nursing and other cancer professional educational
institutions; financial resources; community/volunteer programs for
cancer patients.
e. Identify available opioids and essential medications, opioids policies,
dispensing, and prescription practices, opioid consumption and
administrative management of opioids from each country.
Action Steps Responsibilities Timeline

1. Evaluate Available situational analysis tools ‐ WHO
and surveys and agree on element ‐ Experts
2 months
‐ Facilitators
‐ All members
2. Identify other palliative care experts and ‐ Facilitators
interested member to join the initiative and ‐ Members 1 month
share the same goals

3. Forming a steering committee to be

responsible to conduct the situational 1 month
analysis
4.Conduct wide mapping utilizing members ‐ Palliative Care Panel
from each country, Arab Country Cancer
Conferences, Oncologists Institutions, etc.
2 – 4 months
5. Building a database for the extracted data ‐ ICCAW Organizer
for storage, retrieval, synthesis and
utilization
6. Interpretation of the data and reporting ‐ Palliative Care Panel 2 months
FOLLOW‐UP PLAN

It is very obvious that this conference had a tremendous positive impact, it
generated enthusiasm, opened multiple layers of collaboration and
networking among each countries members, international experts and
multiorganizations.

It is very crucial to continue to instill life into this motion. All members
agreed to be as inclusive as possible to all professionals sharing the same
notion.

All palliative care providers in Arab countries will be invited to participate in
the upcoming projects already many shared interest and enthusiasm to join
from many disciplines. Each member will be delegated a task toward
achieving these objectives.

In addition this panel will serve as a network for information, sharing and
exchange of experience, collaboration, capacity building and advocacy.

As per the organizers, facilitators and scientific committee, at least one follow
up meeting will be planned in the next 1 year. The meeting can be
independent meeting or adjunct to other conference or activity. Continued
communication by e‐mails is crucial to update members, exchange ideas and
information about related activities and news.

CONCLUSIONS

This initiative served as an essential mile stone for wider‐base collaboration
effort to address palliative care needs across the Arab world.

All leaders in palliative care from all Arab countries came along to a common
place with one motion in mind to alleviate the suffering for all cancer patients.

The panel discussed many issues and challenges to the access of palliative care in
the Arab countries and proposed short and long term solutions related to
policies, strategic planning, opioids, education and training, networking and
wide range of collaboration.

The were many layers of multidisciplinary interactions, communications and
collaborations. Palliative Care Panel members have shared discussions and
experiences across various other panels in the initiative including policies, human
resource management, fund raising and access to facilities and medications.

To many participants, these experiences served as a home like and sense of
belonging sense of acknowledgment and recognition. A venue for leadership and
high level communication skills development; a venue for membership,
networking, training and cooperation; a venue forgiving to serve other human
beings; and a venue to share the struggle towards alleviation of suffering.

There is wide range of activities, and there’s a wide boom of palliative care
awareness, capacity building and service development, noticed during the past 5
years in many Arab countries. This conference was the first of its kind to bring all
these hardworking people together to share their experience and to collaborate
together to augment the field, gain more support and moral, be acknowledge
and recognized.

It is very crucial to acquire accurate data and determine the magnitude of the
problem of cancer across all countries in relation to disease burden, opioids
access and availability, available services, experts, policies, education and
programs and resources for funding.19,20

This data will serve as a backbone to advocacy, fund raising, service utilization,
promoting favorable policies and infrastructure for country specific Palliative
Care development in their own countries.

Along with situational analysis all members should focus on wide range Palliative
Care advocacy, capacity and service development.

It is also crucial to get involved in the wider cancer control strategic plans and
implementation hence palliative care is an integral component of that plan.


It is also important to get involved in other panels i.e. policies, access to
medication, fund raising, etc. Since most of the panels complement and share
similar objective to palliative care.

It might not be possible to solve all matters at this stage, however, this initiative
serves as a critical step towards placing palliative care at the center stage of
wider cancer care plan across the Arab World advancing the speciality to higher
levels in the eyes of cancer care providers, policy makers, politicians, founders
and the whole public.

ACKNOWLEDGEMENTS

The palliative care panel facilitators and members acknowledge and
appreciate the enormous support exerted from the initiative organizers, the
supporters, hosting institutions, and the Department of Oncology at King
Abdulaziz Medical City in Riyadh.

Also acknowledge the invaluable advice and support by WHO members
attended the conference and planned future collaboration.

We also acknowledge the endless support and effort from the Administrative
Assistant staff in Particular Neneng Cruz.

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AVAILABLE RESOURCES
Alain, UAE
Type Individual, Affiliation
Specific areas of
Company Governmental, Contact Information
expertise and
Entity Name Organization, Non-Governmental, Location/Address Phone, Fax, Email Website
interest
University Private
Palliative Care Tawam Hospital Governmental PO BOX 15258 Phone +97137677444
Division AL AIN UAE mhidayatullah@tawamhospital.ae
Health Authority of Organization Governmental Health Authority of Abu Phone +97124493333

Abu Dhabi Dhabi www.haad.ae
PO BOX 5674
ABU DHABI
UAE
Ministry of Health Ministry Governmental PO BOX 848 PHONE + 9712 6330000
UAE ABU DHABI WEBSITE : www.moh.gov.ae
UAE
EMRO WHO Organization Non PO Box 7608 Phone +202 2276702535
GOVERMENTAL Nasr city Fax +202 26702492
Cairo 11371 webmaster@emro.who.int
Egypt
Pain Policy Study Pain Advocacy Non governmental 406 Science drive Phone +6082637662
Group Group Suite 202 Fax + 608 2630259
Madison Wisconsin 53711 ppsg@med.wisc.edu
USA
Casablanca, Morocco
Specific areas of
expertise and
interest
University Private
Lalla Salma Organization Non governmental Rabat www.contrelecancer.ma
Association Against
Cancer
Health Ministry Ministry Governmental Rabat www.sante.gov.ma
Moroccan Association Organization Non governmental Casablanca www.amlcc-maroc.org

Against Cancer

East Jerusalem & West Bank, Palestine
Specific areas of
expertise and
interest
University Private
King Hussein Cancer organization Private Amman www.khcc.jo Palliative care
Center program available
Augusta Victoria Hospital Private East Jerusalem Highly motivated

Hospital staff eager to
implement the
hospice program
Palestinian Ministry of Ministry Governmental Ramalla Decision makers
Health and policy makers

Sudan
Specific areas of
expertise and
interest
University Private
Radio-Isotope Center National cancer Governmental Gasr Avenue, Khartoum www.rick.gov.sd Radiotherapy &
Khartoum (RICK) center in Sudan (Federal Ministry of siddikrick@gmail.com Chemotherapy
Health) facilities including
inpatient wards
National Cancer University of Governmental, Medani City Dr. Dafalla AbuIdris Radiotherapy &
Institute Gezira Ministry of Higher dafaallahi@yahoo.com Chemotherapy
Education facilities including
inpatient wards
Soba University University of Governmental, South Khartoum Dr. Suliman Hussein Suliman A general hospital
Hospital Khartoum Ministry of Higher sulimansuliman@hotmail.com affiliated to the
Education Faculty of Medicine,
University of
Khartoum
Dr. Isragha Awad individual Private United Kingdom Ishraqa2002@aol.com A Sudanese Public
and her group Health specialist
Sudan Health
Consultancy Group
Dr. Ahmed El Sayem Individual private MD Anderson Hospital aelsayem@mdanderson.org A Sudanese
(USA) Assiociate
Professor of
Palliative Care
Esther Walker Individual volunteer Khartoum ewalker68@googlemail.com Palliative care
(a palliative care
nurse from UK)
Hospice Africa Organization Non-governmental Uganda, Kampala www.hospiceafrica.or.ug An exemplary
Uganda model of palliative
care services; in
addition to offering
short and long
courses in palliative
care; and advocacy
help
KSA
Specific areas of
expertise and
interest
University Private
King Faisal Specialist Organization Governmental Riyadh, Saudi Arabia www.kfshrc.edu.sa Complete,
Hospital Combined
program
National Guard Organization Governmental Riyadh, Saudi Arabia www.ngha.med.sa Complete,
Hospital Combined
program
Riyadh Military Organization Governmental Riyadh, Saudi Arabia www.rkh.med.sa Partial, Combined
Hospital program
Ministry of Health Ministry ( Governmental Riyadh http://moh.gov.sa Country Health
MOH National) Statistics and
services and
resources
Major hospitals with Organizations and Governmental Riyadh KAMC Cancer Centers
Cancer Centers Universities Jeddah KFSH&RC
(National) Dammam KATC-J
Tabouk KFSH-D
KAUH
Saudi Commission for Organization Non Governmental Riyadh http://arabic.scfhs.org.sa/ National
Health Specialties (National) Accreditation
National Organization Non Governmental USA http://www.NCCN.org/index.asp International
Comprehensive (International) resource for
Cancer Network Cancer Care
NCCN
National Cancer Organization Non Governmental USA http://www.cancer.gov/ International
Institute NCI (International) resource for
Cancer Care

International Resources
Company Governmental, Contact Information Specific areas of
Location/
Entity Name Organization, Non-Governmental, Phone, Fax, Email Website expertise and interest
Address
University Private
World Health Organization Non Governmental Geneva, Switzerland http://www.who.int/en/ International resource for
Organization WHO (International) world health
Oncology Nursing Organization Non Governmental USA http://www.ons.org/ International resource for
Society ONS (International) Oncology Nurses
American Academy of Organization Non Governmental USA http://www.aahpm.org/ International resource for
Hospice and Palliative (International) hospice and palliative
Medicine care HCP
Hospice and Palliative Organization Non Governmental USA http://www.hpna.org/ International resource for
Nurses Association (International) hospice and palliative
care Nurses
International Organization Non Governmental USA http://www.hospicecare.com/ International resource for
Association for (International) hospice and palliative
Hospice and Palliative care
Care IAHPC
Center to Advance Organization Non Governmental USA http://www.capc.org/ International resource for
Palliative Care CAPC (International) hospice and palliative
care: starting programs,
tools, etc.
National Association Organization Non Governmental USA http://www.naswdc.org/ International resource for
of Social Workers (International) oncology and hospice
and palliative care Social
Workers
Pain & Policy Studies Organization Non Governmental USA http://www.naswdc.org/ International resource for
Group PPSG (International) Countries for General
Opioid Consumption
African Palliative Care Organization NGO PO Box 72518 www.apca.org.ug Increase palliative care
Association Plot 850 Dr Gibbons Road info@apca.org.ug across the African region
Kampala, Uganda including advocacy,
standards, drug
Tel: +256 414 266251 availability, education,
Fax: +256 414 266217 technical support
Cairdeas Trust Organization NGO Scotland Via medical director Dr Support palliative care
Mhoira Leng dr@mhoira.net development through
mentorship, education
and consultancy
Scottish Partnership Organization NGO Scotland www.palliativecarescotland.or Useful publications and
for Palliative Care g.uk policy documents
National Council for Organization NGO UK www.ncpc.org.uk Useful publications and
Palliative Care policy documents
Palliative Care Toolkit Educational UK www.helpthehospices.org.uk Excellent introductory
resource and search for Toolkit and textbook and training
Training Manual manual
National Cancer Policy and Control Programs Inaugural Meeting Report

National Cancer Policy and

Control Programs
National Cancer Policy and Control
Programs
Dr. Abdullah Al Amro
*on behalf of the National Cancer Policy and Control Programs Panel
Members

OBJECTIVES
Discuss WHO/IARC plans to improve cancer care.
Present ongoing initiatives to improve cancer care.
Present recommendations on establishing National Cancer Control Programs.

PANEL MEMBERS

Facilitator
Dr. Abdullah Al Amro Board Director Saudi Cancer Society KSA
Name Institution Country
Dr. Khaled Al Saleh GFCC Kuwait
Dr. Ahmed Al Mazroie Qatar
Dr. Salem Chammas Lebanon
Dr. Shereena Al Mazroie Health Authority of Abu Dhabi UAE
Dr. Afeef Al Nabhi Yemen
Dr. Ibtihal Fadhil WHO/EMRO
Dr. Sami El Badawy National Cancer Institute Egypt
Junna Ibardolasa ibardolasaj@ngha.med.sa +96612520088 Ext 14069
Fax: +96612520088 Ext 14691
Mona Al Nuisser malnuisser@kfmc.med.sa +9662889999 Ext. 8138
Guest Panel
Name Institution
Dr. Jalaa Taher Health Authority of Abu Dhabi
Dr. David Carr GE, Abu Dhabi
Dr. Ahmed Sagher KFSH ‐ Dammam
Dr. Nahla Gafer RICK
Dr. Mhoira Leng
Dr. Omar Shamieh KAMC ‐ Riyadh
Dr. Rima Khadra Roche
Dr. Nafisa Abdelhafiez KAMC ‐ Riyadh
Dr. Khalid Qatamish KAMC ‐ Riyadh
Dr. Adele Kating MOH ‐ Syria
Dr. Yousef Al Awlah KAMC ‐ Riyadh
Dr. Nour Obeidat KHIBC
Dr. Rafa Al Shehri KAMC ‐ Riyadh
Dr. Reem Al Hayek KFDHD
Dr. Ahmed Baredah National Oncology Center ‐ Yemen

Dr. Shahinaz Bedri AHFAD University
Rosalina F. Abras RKH
Rowela Arias RKH
Catherine De Paz RKH
Hazel Joy Alarde RKH
Josephine Trinidad RKH
Doodie Paglingayen RKH

Abstract

Background : Cancer is a major public health burden causing more deaths than
AIDS, Tuberculosis and Malaria combined. Even though there are more than 200
types of Cancer, Lung, Breast, Prostate, and Bowel Cancer are representing more
than 50% of the Cancers with 12 million cases diagnosed globally with Cancer
every year. In spite of the advancement in technology Cancer remains a major
health care challenge with a mortality rate of 60‐70% in developing countries and
30‐40% in developed countries. Arab world will face major challenge unless
comprehensive cancer control program is adopted. We are proposing few
milestones to start cancer control strategy for the Arab world.
Methods: Panel experts were selected from different countries with great
diversities. All are in the field of cancer care. Data were collected regarding
situation analysis with SWOT methodology and proposed objectives and available
resources. During the conference open discussion was used with nomination
technique to identify short term and long term priorities.
Results: Most of the national cancer control initiatives in the Arab world is either
primitive or non existing. There are major needs to start with establishing national
cancer control committee in every country. The committee will be in charge of
design strategy in accordance with WHO/IARC plan and oversee the
implementation steps. It is highly recommended that a national annual cancer
meeting is held to update workers in the health field about the new in cancer care
and the strategy implementation. Long term strategy is to ensure all Arab
countries have comprehensive cancer control program with establishing data
bases for the Arab countries. An Advisory board for cancer care with
representation from the heads of the national cancer control committee in each
country is advised.
Conclusion : Sort term and long term recommendation is presented with emphasis
to unify intra‐country and inter‐countries effort to control cancer.


Introduction

Cancer is a major public health burden causing more deaths than AIDS, Tuberculosis and
Malaria combined. Even though there are more than 200 types of Cancer, Lung, Breast,
Prostate, and Bowel Cancer are representing more than 50% of the Cancers with 12
million cases diagnosed globally with Cancer every year. This number is expected to reach
15 million in 2020 with expected mortality of 12 million. In spite of the advancement in
technology Cancer remains a major health care challenge with a mortality rate of 60‐70%
in developing countries and 30‐40% in developed countries. It is the second leading cause
of death in developed countries and has a major economical impact on health care
spending.
The incidence of Cancer varies from country to country due to differences in
demography, and risk factors.
Ma and Yu et all have shown the cancer burden in different regions

Since cancer is mainly a disease of the elderly ( fig2) the expected number of cases will
grow exponentially in the coming few years due to aging population which increase the
care burden especially in our countries.

The magnitude of Cancer burden will be more apparent in our countries. As we can see in
the graph we have a Population pyramid with a wide base. The movement of population
from A young age group to seniority will reflect in the number of Cancer cases. The
magnitude will be slightly less in developed countries since the rate of change will be less
significant. Unless there is a strong global initiative to prevent cancer and introduce
screening programs we will be facing a challenge which is beyond healthcare providers
capabilities. WHO and other healthcare regulatory agencies, as well as non governmental
agencies, in anticipation of what will happen in the future, have introduced a
recommendation to establish national cancer control program


Methods and Materials
The efforts started more than 6 months by identify cancer care experts from
different regions and selection was based on their experience and knowledge about
cancer care strategy. Who experts Dr. Ibtihal Fadhil and Dr.Cecilia Sepulveda were
important advisors for the panel.
Panel Objectives:
1‐ To review the current status of the national cancer control program in the
Arab world
2‐ To present current initiatives in cancer control
3‐ Identify possible recourses for cancer control
4‐ Write recommendation for short and long term for cancer control.

The is great interest both in governmental level and individuals to have cancer
control program.
Availability of good experiences in certain Arab countries both in early
screening and therapeutic approach.
Very active NGOs in many countries.
There are highly specialist native doctors who have interest in developing
national control program.

Lack of clear strategy for cancer control.
Great diversity between Arab countries.
Lack of enough resources.
Lack of accurate data
Poor communications between cancer care providers.
Lack of cancer care policies.
Lack of proper awareness program. '
Lack of palliative care.
Lack of cancer research.


Recommendations

Table: Panel Recommendations
1. Develop national Establish national cancer control Establish the committee.
cancer control committee with equal High authority endorse
program. representation from stakeholders. the committee and the
Adopt WHO recommendation. strategy.
2. Communication Improve communication between Survey the communication
stakeholders and communicate your effectiveness.
control plans to all health care
providers.
3. Project plan for Establish a program with right Have milestones of the
implementation governance and clear project plan. national strategy
translated into key
performance indicators.



4. Policy Identify the stakeholders and write Have the policy
clear policy for the completed within a
implementation with the role of year.
each member of the stakeholders.
5. External review Have international experts to Have annual audit
review the strategy and the program.
implementation process.
6. Ensure support. Have the strategy communicated Write comprehensive

well to the highest authority to report to the highest
gain their support. authority.

2020 OBJECTIVE
Implement a National Cancer Control Plan in each country.
Action Steps:
vi. Establish a Pan‐Arab Cancer Control Advisory Committee.
vii. Establish a National Cancer Control Committee in each country.
viii. Adapt the WHO Cancer Control Strategy.
ix. Develop/review National Cancer Control plan in line with the WHO Regional
Cancer Control Strategy.
x. Establish a cancer control database (stakeholder organizations) in each
country.

12 MONTH PROJECT
Develop a process to help establishing national cancer control committee
with high level representation and term of reference.
Establish an annual national cancer care meeting.

Conclusions:
Cancer control program is complex especially when implemented in highly diverse environment with lack of
enough resources however we believe the above recommendation is adopting step wise approach with aim
to move toward comprehensive control program in 2020.



Available Resources:
The resource list will include any individual or entity that may help as a resource to
the regions in the topic discussed. The documents should include the entity name,
affiliation, type of entity, contact information and areas of expertise. These
entities may include:
f. Agencies and Organizations: Local, national and international,
governmental and nongovernmental, charitable and non charitable
g. Academic Institutions, university, colleges
h. Websites
i. Individuals

Type Affiliation
Entity Name Company Non‐ Location / Address Phone, Fax, Email expertise and
Organization, governmental, Website interest
University Private
Central Cancer
1. Tawam Government Johns Hopkins Registry Tel: 00971‐3‐7072686 To deliver timely,
Hospital, in Hospital Medicine Radiotherapy Fax: 00971‐3‐7075094 comparable and
affiliation Department, 1st Email: high quality data
with Johns Floor CCR@tawamhospital.a by collecting
Hopkins Tawam Hospital in e information on
Medicine; affiliation with Website: every new
Central Johns Hopkins http://www.tawamhos diagnosis of cancer
Cancer Medicine pital.ae/ccr/default.asp occurring in
Registry P O Box: 15258 population of Abu
Al Ain Dhabi.
United Arab It is a cancer
Emirates registry leading
Tel: 00971‐3‐ expertise
7072686 department in the
Fax: 00971‐3‐ region.
7075094
Email:
CCR@tawamhospi
tal.ae
For Adult Oncology,
2. Tawam Government Johns Hopkins Department of Please contact: Oncology & Breast
Oncology Hospital Medicine Oncology Tel#: +971‐3‐7074466 Care Center
Center Tawam Hospital Fax #:+971‐3‐7074468
P.O. Box: 15258, Al For Children Oncology,
Ain, UAE please contact:
Tel#: +971‐3‐7072901
Fax #:+971‐3‐7072935
For Breast Care Center,
please contact
Tel#: +971‐3‐7074330
or 7074331
Fax #+971‐3‐7670811
For Medication Issues,
please contact
(pharmacy) Telephone

#: +971‐3‐7075092
Fax #: +971‐3‐7075091
Oncology Clinic &
Infusion Center
Tel#: +971‐3‐7074101
Fax #: +971‐3‐7075150
Radiotherapy/Palliative
Care Clinic
Telephone #: +971‐3‐
7072780
Fax #: +971‐3‐7075114
Website:http://www.ta
wamhospital.ae/oncolo
gy/index.asp

3. Rafik Government Lebanese Beirut Tel 00961 1 830000 Comprehensive
Hariri Hospital University, and cancer diagnosis
University American and treatment
Hospital university of facilities with a
Beirut team of highly
trained physicians
and support staff

4. Lebanese NGO Beirut
Cancer
society

5. Faire Face Cancer survivors Beirut Reaching out to
association cancer patients in
terms of moral
support.


Research Development Priorities in the Arab Countries Inaugural Meeting Report

Research Development

in the Arab
Countries


Research Development Priorities in the
Arab Countries
Dr. Ali Shanqeeti
*on behalf of the Research Development Priorities in the Arab Countries Panel Members

OBJECTIVE
Overview of Research challenges in the Arab countries.
Overview of Research activities in the Arab countries.
Present recommendations on building research structure and culture.
Present recommendation on setting priorities of research.

PANEL MEMBERS

Facilitator
Dr. Ali Shanqeeti Chairman, National Health Services KSA
Committee for Cord Blood Council
Stem Cells

Co‐Facilitator
Dr. Sana Al Consultant, Medical University of Jordan Jordan
Sukhun Oncology and Hematology

Dr. David Kerr Chief Research Advisor Sidra Medical and Qatar
Research Center

Dr. Alex Adjei Senior Vice President, Roswell Park Cancer USA
Clinical Research Institute
Professor and Chairman,
Department of Medicine
Katherine Anne Gloia
Chair in Cancer Medicine

Dr. Alhareth Director of Research Hamad Medical Qatar
Alkhater Center Corporation

Dr. Hani Tamim Associate Professor King Abdulaziz Saudi Arabia
Medical Education Medical City
Dr. Ali Hajeer ASHI Director Head, King Abdulaziz Saudi Arabia
Immunopathology Medical City
Laboratory




Dr. Fadwa Atiga Assistant Director for King Hussein Institute Jordan
Scientific Affairs Director, for Biotechnology &
Office of Science, Health Cancer
and Research Policy

Dr. Abdulrahman Consultant, Division of King Abdulaziz Saudi Arabia
Sultan Pediatric Hematology Medical City
Oncology, Department of
Oncology
Dr. Saleh Al Director, Clinical Saad Specialist Saudi Arabia
Tuwaijri Research Laboratory Hospital
Dr. Elsayed Associate Professor Regional Oman
Salim Representative for
the Arab World
APOCP/UICC, Asian
Regional Office (ARO)
Hanan El Dessouki eldesoukih@ngha.med.sa +96612520088 Ext 14689
Fax: +96612520088 Ext 14691
Panel Guest
Name Organization
Dr. Mohamad Alshaqi Riyadh Military Hospital
Dr. Suad M. BinAmer KFSH & RC
Dr. Lislie Lehmann Children Hospital ‐ Boston
Dr. Reem Al Sudairy KAMC ‐ Riyadh
Dr. Shahinaze Bedri AUW ‐ Sudan
Dr. Naima Al‐Mulla HMC ‐ DOHA
Dr. Ali Alshehai KKUH
Nada Hamdi KAMC ‐ Riyadh



ABSTRACT

Background: A diverse group of individuals from different countries, backgrounds
and expertise formed a human resource development panel to develop
recommendations on how to improve the human resources related to cancer care
as a part of the Initiative to Improve Cancer Care in the Arab World (ICCAW).

Methods: The panel members completed an assessment tool including
situational analysis, objectives, recommendations with action steps and indicators
and available resource to support the objectives of the panels. The input was
compiled and consensus was reached about the final recommendations which are
included in this report.

Results: There were uniform agreement on the need to have more oncology
health care workers (HCW) including physicians, nurses and other support staff.
Various recommendations about training programs both at the undergraduate and
post graduate levels were suggested.

Conclusion: The Research Panel put forth recommendations and other useful
information to help countries in the region improve on their human capital for
cancer.



I. Introduction
Without the work of thousands of cancer researchers worldwide, many of
cancer survivors’ lives would be very different. Over a relatively very short
time, cancer research has helped to increase survival rates and improve the
lives of millions of people worldwide. In the 1940s on average, only one out
of four patients diagnosed with cancer survived in the developed countries.
By the 1960s, as research and treatments advanced, the average survival
rate was up to one in three, and today, 50 percent of all patients diagnosed
with cancer in these countries will survive for an extended period of time.
Not only are many more patients surviving their original cancer diagnosis,
but they are also enjoying a better quality of life while being treated. Again,
thanks to the work of cancer researchers, surgery is, in many cases, less
radical and invasive, and chemotherapy side effects are better managed
through new medications. But despite impressive progress in research and
treatment, cancer remains much harder to prevent and cure than many
other diseases. More needs to be done to improve cancer diagnosis and
treatment, and reduce the death rate in the developed countries.
The cancer research situation in the developing countries, which include all
the Arab countries, is even more desperate and certainly more challenging.
Not only is the cancer outcome is less optimal in these countries but also
the contribution of local cancer research activities, both regionally and
globally, is minimal.
This report attempts to address the current cancer research situation in the
Arab World. In addition, it will present recommendations on building
cancer research culture and setting priorities for cancer research in the
region.

II. Methods and materials
Panel Formation
As part of the Initiative to Improve Cancer Care in the Arab World, a
Research Development Priorities panel was formed from individuals
involved in the cancer research and care in the region in different areas and
backgrounds.

Initial Assessment and Recommendations Tool (IART):
a.) To conduct a brief situation analysis including challenges and strengths.


b.) Provide strategic recommendations to address certain objectives including
c.) Specify a doable objective to be achieved in the next 12 months.
d.) Compile a list of available resources anywhere in the world which can
provide support and help to the region in this project.
The responses were compiled in one document which was discussed with the
panel members and participants in the meeting. A consensus conclusion was
reached by majority vote among the participants in the panel sessions.

III. Situational Analysis in Findings
A. Strengths : The following strengths in cancer research activities in
the Arab World were identified by the panel participants:
1. The presence of strong political will and support to establish
research culture (including cancer research) in several Arab countries. For
example, there is a strong support for research in Saudi Arabia lead by the
visionary leadership the Custodian of the two Holy Mosques, King Abdullah
bin Abdulaziz. In Qatar, cancer care & research has been identified as a
national priority. The recent increased focus on the importance of research
stems from the fact that many of these research initiatives aim at
addressing the increasing burden, financial and otherwise, of diseases such
as cancer. Some of the regional unique features of cancer in the region (e.g.
different genetic background) require the adoption of appropriate skeptical
attitude towards the knowledge received from the developed countries
which requires mature research activities. In addition, many of these
countries see research activities as very important components of
establishing a strong knowledge based economy and hence become more
competitive in an increasingly global market. Furthermore, such activities
will contribute, at least in part, towards the “technical sovereignty” of these
countries. Several countries in the region has allocated (e.g. increased
funding for medical research in Saudi Arabia, Qatar foundation, Emiri
decree to allocate 2.8% of the GDP to national research funding in UAE).
This political and financial support has resulted in the creation of several
initiatives in the region (e.g. the national research fund and the biomedical
research institute in Qatar, the national health research strategies in Saudi
Arabia and Oman, several national programs to promote innovation and
entrepreneurship in Saudi Arabia, , …etc)
2. The presence of “core” infrastructure in several Arab countries. This


core infrastructure can be leveraged to establish a very strong foundation
to conduct high caliber research relevant to the region. Such infrastructure
facilities include good number of medical schools and other allied health
sciences schools, several research laboratories dedicated to cancer
research and tertiary cancer centers with emphasis on clinical research
3. In terms of human capacity, the participants have identified several
strengths in the Arab countries. These include the presence of qualified
personnel many of whom are enthusiastic about being involved in research
activities, postgraduate training programs in cancer related research areas
(clinical fellowships, biochemistry, molecular biology. biostatistics …etc)
and scientific and technical partnerships with world renowned institutions.
The participants however acknowledged the extensive variations in the
quality and capacity of these various programs across the Arab countries.
4. The availability of information is an important pre‐requisite for
deciding on research priorities in the region and several Arab countries
have well established national cancer registries (e.g. all GCC countries,
Jordan, Syria, Lebanon, Iraq) as well as many hospital based cancer
registries. These registries can potentially be a gold mine for addressing the
research priorities in the Arab countries.
B. Weaknesses: Despite the above mentioned strengths, the
participants have identified several areas of weakness related to cancer
research in the Arab countries. These weaknesses include:
1. Weaknesses related to human capacity include limited years of
both individual and cumulative experience of the current manpower,
paucity of experienced mentors, and limited exposure to training in
research methodologies.
2. As far as education and training are concerned, the members
identified the following weaknesses:
a) Limited role for the basic education system in establishing
the research culture (e.g. more emphasis on "Producing
practitioners for application of imported knowledge" rather than on
innovation resulting in creation of a culture of consumerism with
little ownership, little emphasis on awareness about the importance
of research)
b) In many Arab Countries, basic & translational research are
not well established yet
c) Limited programs addressing development of cancer
research methodologies and technical capabilities on the central
and regional levels.


3. There were several weaknesses related to Research Policies and

other Legal issues in the Arab Countries. These include lack of clear cancer
research strategy, inadequately established institutional review boards (or
ethics committees) both nationally and locally, inefficient import and
export rules, immature intellectual property rights laws, and insufficient
"protected” time for clinicians/practitioners to spend in research.
4. Fragmentation and weak collaboration among countries,
institutions and individuals which resulted in very few national
collaborative clinical studies and very few multidisciplinary research groups
in the region.
5. Information necessary for research foundation is limited largely
because of lack of “networking” among the current national cancer
registries, concerns surrounding the accuracy of the data captured,
inconsistent data collection standardization.
6. Implementation and utilization suffer from imbalance (e.g more
emphasis on researcher based vs. strategy based projects), irrelevance
because of “Imported” projects more than “native” projects, and small
number of patients therefore trial recruitment may prove difficult, reactive
(rather than pro‐active) implementation and utilization of research
outcome.
7. The cancer research infrastructure is insufficient in many Arab
countries with few resources available at the institutional level to conduct
cancer research.
C. Opportunities: The opportunities in the Arab countries are felt to be
huge since the cancer research in these countries is still a “green” field
which potentially can be the ground for major breakthroughs. In addition,
cancer in the Arab countries has some unique features (e.g. genetic
heterogeneity, special environmental factors) which could be the focus of
important research projects.
D. Threats: The participants identified several issues that can threaten
the potential progress in cancer research in the Arab countries. These
threats include distraction by glamour rather than need both within a
country and between countries which in many times puts more focus on
competition rather than collaboration, Improper utilization of the already
limited resources, and exodus of "minds" and "brains" (“brain bleed”) to
other countries.


IV. Recommendations

The following table includes the recommendations submitted by panel members in
addition to specific action steps needs to be taken to achieve the objectives.
Measurable indicators were identified to help determine whether the goal is
achieved or not. These were discussed in the panel sessions to reach consensus
recommendations.
Objective 1 ‐ Establish a courses for physicians on ‐ Number of courses conducted per
Train clinical how to perform clinical research, year.
oncologist to conduct i.e. epidemiology, biostatistics, and
a high standard writing grants and therapeutic ‐ Number of junior oncologist joining KAIMRC is
clinical research. protocols. the mentorship program. establishing a
(Human Capacity ‐ Establish a mentorship program for biobank and would
Building) junior oncologist. ‐ Number of clinicians attending be ready to store
‐ Send physicians to attend excellent workshops in clinical research samples
courses and workshops in the US or arranged by American or European
Europe e.g. ASCO/AACR workshops societies.
(Vail workshop)or if feasible to
arrange for these courses to be ‐ Number of Publications in the field
conducted in the Arab World. of clinical oncology
‐ Number of participating centers

‐ Number of patients
recruited/month and year

‐ Identify the commonest cancer

‐ Number of blood samples stored
Objective 2
‐ Organize with MOH a registry for

those common cancer ‐ Number of qualified cancer
Start tissue/blood
researchers
biobanks
‐ Collect after IRB approval blood and

tissue for biobanking. ‐Approval of funding

‐Publications and/or patents

Objective 3‐ Develop programs specialized for ‐Approval of funding
Recruit and train cancer research ‐Publications and/or patents
more people ‐ Recruit qualified cancer researchers
epidemiology and
biostatistics in
general, and
specifically in cancer
research

Objective 4
Establish Arab
Oncology Research ‐Recruit members. ‐Establishment of network.
Network ‐Establish office. ‐Number of members.
‐Establish research priorities ‐Number of publications.




Objective 5 ‐Develop educational programs. ‐Number of funding organizations.
Increase cancer ‐Develop funding programs. ‐Number of proposals.
research in the Arab ‐Recruit & maintain scientists & ‐Number of scientists & clinicians
World clinicians involved in cancer research.
‐Encourage collaborative projects. ‐Number of clinical trials.
‐Number of patients enrolled in
clinical trials.
‐Number of published clinical trials
Objective 6 ‐Development of cancer registries. ‐Number of cancer registries.
Improve cancer ‐Training of cancer registry staff. ‐Number of qualified staff in cancer
registry databases ‐Develop data on outcomes registries.
‐Amount & quality of data collected.
Objective 7 ‐ Construct outline plan Erection of high quality well
Build a Biomedical ‐ Attract funding equipped laboratory
Research Institute to ‐ Design and build
house
basic/translational
researchers

Objective 8
Establish a Clinical
Research Centre to ‐ Establish partnership with leading ‐ Number of protocols established
facilitate trial international Trials office ‐ Number of patients recruited to
protocol ‐ Joint appointment of key personnel trials portfolio
development and ‐ Rearrange consultant job plan to ‐ Quality assurance that data
management include research sessions management meets GCP standard.

‐ Increase trial recruitment
‐ Increased patient awarenes
Objective 9 ‐ Communication plan to explain
Public awareness research, ethical framework and ‐ Number of PhD, MD‐PhD
raising on benefits of societal benefits ‐ Collaborative projects
volunteering for ‐ Arrange conference for leading ‐ Scientific papers
research programs cancer centres ‐ Number of patents

Objective 10
Reinforce the ‐ joint degrees and research
technology transfer /innovation agreements between Arab
and capacity building universities and their American and
and adapt it to the European counterparts
Arab countries
environment
Objective 11 ‐ Encouraging post‐graduate studies Number of new studies
‐ Spread research and fellowship programs Number of patients accrued to trials
culture, promotion of ‐ Initiating research development
scientific approach, committees in most institutes
development of ‐ Establishing training programs
research skills among ‐ Building reactions and links between
personnel of the researchers either locally and/or
health sector internationally
‐ Encouraging highly qualified
researchers for attending conferences
and meetings



Objective 12 ‐ Establishing Ethical and Review Number of IRBS
Commitment to committees in the Arab world is Number of institutions accredited
standard regulation necessary for good quality of research
of scientific research output
protocols and ethical ‐ Initiating programs for accreditation
consideration to in all institutes
ensure high quality ‐ Training programs for ethical
of research consideration, scientific research
regulations, presentations and writing
of scientific papers

THE YEAR 2020 SUMMARY OBJECTIVE:
The following objective and action step was selected for the 2020 by the Research
Development Priorities Panel:
Initiate and conduct rigorous, collaborative cancer research activities, in all Arab countries
according to resource availability.
Action Steps:
i. Establish a Pan Arab Cancer Research Steering Committee.
ii. Promote active participation of oncology clinicians in clinical trials and other
relevant research.
iii. Establish research training programs, open to researchers throughout the
region.
iv. Establish a Pan Arab Cancer Research Collaborative Network.
v. Promote translation of findings into clinical practice, as appropriate for each
country.
vi. Establish cancer care “Outcomes and Effectiveness Research” centers and
programs in the region.



The next 12 months projects
The following includes suggestion of doable projects that can be achieved over the next 12
months.
Table: 12 Month Project for the Research Development Priorities in the Arab Countries

Objective Action Steps Suggested Required Funding / Other Required Timeline Other Comments
Responsible Source Resources
Person / Entity
1‐ Arrange for a 1‐ Invite Ali Alshanqeeti/ KACST 1st three months: Several annual

workshop on international Abdulrahman Jazieh plan details of workshops are
methodology of speakers. workshop and well established in
cancer research 2‐ Encourage names of speakers KSA for the last
physicians and 3‐6 months: several years
trainees to advertise for the
participate (each workshop and
should have a start enrolling.
written protocol Also to explain to
prior to workshop participant the
to achieve details of the
maximum benefit) required protocols
6‐11 months:
Provide help as
needed. at
12 month: conduct
the workshop with
the goal that each
participant will
come out with a
well written
protocol that can
be submitted to
local IRB

2‐ Establish an 1‐ Obtain initial 1‐Abdulrahman
Arab approval Jazieh /Ali
Cooperative 2‐Call for an initial Alshanqeeti
Oncology Group “founders” meeting 2‐ Members of the
(ACOG). 3‐Establish group
framework and
timeline
4‐Define initial
projects



V. Follow‐up Plan
The panel members will establish plans to sustain its momentum and
continue its work in the future. At least one follow up meeting should be
planned in the next 1 year. The meeting can be independent meeting or
adjunct to other conference or activity. A working group will be formed to
address the 12 months project with close follow up with all involved.

VI. Conclusions
Cancer Research in the Arab countries faces many challenges in spite of
recent strides forward in this arena. This report includes certain
recommendations that may help interested parties improve the situation of
the cancer in the region which will be translated into improving the care of
cancer patients in the region.



VII. Available Resources

Type
Affiliation
Individual, Contact Information Specific areas of
Location /
Entity Name Company Governmental, expertise and
Address
Non‐governmental, Phone, Fax, Email Website interest
Organization, Private
University
KSA:

All universities
and tertiary care
www.kacst.edu.sa
centers in Saudi

Arabia have
www.kfshrc.edu.sa
available funding

for research
www.ksu.edu.sa
examples are
National/ Government Riyadh

www.kau.edu.sa
King Abdulaziz
Organization Riyadh
City for Science
www.ksau‐hs.edu.sa
and Technology

(KACST)
www.kaust.edu.sa

King Faisal
www.kfmc.med.sa
Specialist
Hospital and
Research
center


Type
Affiliation

Individual, Contact Information Specific areas of
Governmental, Location /
Entity Name Company expertise and
Non‐ Address
Phone, Fax, Email Website interest
governmental,
Organization,
Private
University

http://www.nha.org.qa/sch/En/i
‐National Health
Qatar: ndex.jsp
Authority
‐Governmental
‐
‐Supreme Council of ‐ ‐National research

Health Doha http://www.qf.org.qa guidelines
‐Organization
‐ ‐ ‐
‐

‐Qatar Foundation ‐Private Doha ‐Funding &
‐Organization
‐ ‐ http://www.hmc.org.qa promotion of
‐
research

‐Hamad Medical ‐Government Doha ‐
‐
Corporation ‐

‐ http://qatar‐weill.cornell.edu/ ‐Cancer Care
‐Medical School
‐ Doha ‐Research
‐
‐Weill Cornell ‐

Medical College – ‐Private
‐
Qatar ‐ ‐

‐
‐Academic
‐ Doha http://www.sidra.org/en/Pages/ ‐Research
Medical Center
‐Sidra Medical & Default.aspx ‐
‐
Research Center ‐Private

‐ ‐ ‐
‐Nursing School

‐
‐University of ‐ Doha http://www.qatar.ucalgary.ca/ ‐Research

Calgary – Qatar ‐
‐
‐ ‐Private

‐ Doha ‐Research
‐University
‐Qatar University http://www.qu.edu.qa/ ‐
‐
‐ ‐

Doha ‐Research Funding
‐Organization
‐Qatar National ‐Public ‐
‐
Research Fund ‐ http://www.qnrf.org/

‐ Doha ‐Cancer Research
‐
‐Private

‐Dr. David Kerr
‐Member of
dkerr@sidra.org
Supreme Council
of Health



Type
Affiliation

Individual, Contact Information Specific areas
Governmental, Location /
Entity Name Company of expertise
Non‐ Address
Phone, Fax, Email Website and interest
governmental,
Organization,
Private
University

Sultanate of
‐Asian Pacific
Oman:
Organization for
‐Dr. Malcolm
Cancer
Moore Cancer
Prevention
‐ ‐Non‐ Thailand apocpcontrol@yahoo.com epidemiology,
‐
Governmental Cancer

‐Prof. Murat Prevention
‐Director of
Tuncer and Control
Cancer Control
‐ http://apocp2010.net/
Deprt. M.O.H
‐Governmental Turkey
Turkey
‐
‐ Cancer Control

‐
‐Coordinator of ‐ Non‐

the Asian Pacific Governmental
‐Dr. Elsayed Egypt Elsalem_777@yahoo.com Cancer
Organization of
Salim Research
Cancer
‐
Prevention for
the Arab World










Arab World Cancer Declaration, 2010. (Initiative To Improve Cancer Care in The Arab World)

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Arab World Cancer Declaration, 2010. (Initiative To Improve Cancer Care in The Arab World)

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Initiative to Improve Cancer Care

2. To facilitate networking, experiences sharing, cooperation and collaborative

Funding Policy Human

ii. Support enforcement of anti‐tobacco legislation, such as banning

v. Promote translation of findings into clinical practice, as appropriate

‫‪ ‬ﺑﻴﺎن اﻟﻌﺎﻟﻢ اﻟﻌﺮﺑﻲ ﻟﻤﺮض اﻟﺴﺮﻃﺎن‬

‫ﺷﻜﻞ ‪ . 1‬ﺗﺼﻨﻴﻒ اﻟﺮﻋﺎﻳﺔ اﻟﺸﺎﻣﻠﺔ ﻟﻤﺮﺿﻰ اﻟﺴﺮﻃﺎن وﻣﻜﺎﻓﺤﺘﻪ ﺑﺎﻟﻌﺎﻟﻢ اﻟﻌﺮﺑﻲ‬

‫‪Initiative to Improve Cancer Care in the Arab World ‬‬ ‫‪ ‬‬ ‫‪22 ‬‬ ‫‪ ‬‬

‫اﻷهﺪاف اﻷﺳﺎﺳﻴﺔ ﻟﻌﺎم ‪ 2020‬وﺧﻄﻮات اﻟﻌﻤﻞ اﻟﺮﺋﻴﺴﻴﺔ‬

‫ﺧﻄﻮات اﻟﻌﻤﻞ ‪:‬‬

‫ﺧﻄﻮات اﻟﻌﻤﻞ ‪:‬‬

‫ﺧﻄﻮات اﻟﻌﻤﻞ ‪:‬‬

‫ﺧﻄﻮات اﻟﻌﻤﻞ ‪:‬‬

‫‪Initiative to Improve Cancer Care in the Arab World ‬‬ ‫‪ ‬‬ ‫‪23 ‬‬ ‫‪ ‬‬

‫ﺧﻄﻮات اﻟﻌﻤﻞ ‪:‬‬

‫ﺧﻄﻮات اﻟﻌﻤﻞ ‪:‬‬

‫ﺧﻄﻮات اﻟﻌﻤﻞ ‪:‬‬

‫‪Initiative to Improve Cancer Care in the Arab World ‬‬ ‫‪ ‬‬ ‫‪24 ‬‬ ‫‪ ‬‬

‫ﺧﻄﻮات اﻟﻌﻤﻞ ‪:‬‬

‫ﺧﻄﻮات اﻟﻌﻤﻞ ‪ :‬‬

‫ﺧﻄﻮات اﻟﻌﻤﻞ ‪ :‬‬

‫ﺧﻄﻮات اﻟﻌﻤﻞ ‪:‬‬

‫‪Initiative to Improve Cancer Care in the Arab World ‬‬ ‫‪ ‬‬ ‫‪25 ‬‬ ‫‪ ‬‬

‫وﻗﻊ ﻧﻴﺎﺑﺔ ﻋﻦ اﻷﻓﺮاد واﻟﻤﻨﻈﻤﺎت اﻟﻤﺸﺎرآﺔ ﺑﺘﺎرﻳﺦ ‪2010/4/24‬‬

‫‪Initiative to Improve Cancer Care in the Arab World ‬‬ ‫‪ ‬‬ ‫‪26 ‬‬ ‫‪ ‬‬

‫اﻟﻤﺸﺮﻓﻮن ﻋﻠﻰ ﻣﺠﻤﻮﻋﺎت اﻟﻌﻤﻞ ‪:‬‬

‫‪ -‬اﻟﺒﺮاﻣﺞ اﻟﻮﻃﻨﻴﺔ اﻻﺳﺘﺮاﺗﻴﺠﻴﺔ ﻟﻤﻜﺎﻓﺤﺔ اﻟﺴﺮﻃﺎن‬

‫‪ -‬ﺗﻤﻮﻳﻞ رﻋﺎﻳﺔ ﻣﺮﺿﻰ اﻟﺴﺮﻃﺎن‬

‫‪ -‬اﻟﻜﺸﻒ اﻟﻤﺒﻜﺮ ﻋﻦ اﻟﺴﺮﻃﺎن‬

‫‪ -‬ﺗﻨﻤﻴﺔ اﻟﻤﻮارد اﻟﺒﺸﺮﻳﺔ‬

‫‪ -‬ﺗﺸﺨﻴﺺ ﻣﺮض اﻟﺴﺮﻃﺎن‬

‫‪ -‬ﻣﻌﺎﻳﻴﺮ اﻟﺮﻋﺎﻳﺔ واﻻرﺷﺎدات ﻟﻠﺪول اﻟﻌﺮﺑﻴﺔ‬

‫‪ -‬أوﻟﻮﻳﺎت ﺗﻄﻮﻳﺮ اﻷﺑﺤﺎث ﻓﻲ اﻟﺪول اﻟﻌﺮﺑﻴﺔ‬

‫‪ -‬ﻣﺮاﻓﻖ اﻟﻌﻨﺎﻳﺔ ﺑﻤﺮﺿﻰ اﻟﺴﺮﻃﺎن‬

‫‪ -‬اﻟﺤﺼﻮل ﻋﻠﻰ أدوﻳﺔ ﻋﻼج اﻟﺴﺮﻃﺎن‬

‫‪Initiative to Improve Cancer Care in the Arab World ‬‬ ‫‪ ‬‬ ‫‪27 ‬‬ ‫‪ ‬‬

‫‪ -‬اﻟﺘﻐﻠﺐ ﻋﻠﻰ ﺗﺤﺪﻳﺎت رﻋﺎﻳﺔ اﻷﻃﻔﺎل اﻟﻤﺮﺿﻰ ﺑﺎﻟﺴﺮﻃﺎن ﻓﻲ اﻟﻌﺎﻟﻢ اﻟﻌﺮﺑﻲ‬

‫‪Initiative to Improve Cancer Care in the Arab World ‬‬ ‫‪ ‬‬ ‫‪28 ‬‬ ‫‪ ‬‬

‫اﻟﺨﺒﺮاء واﻟﻤﺴﺘﺸﺎرون اﻟﺪوﻟﻴﻴﻦ ‪:‬‬

‫اﻟﺪآﺘﻮرة ‪ /‬ﺳﻴﺴﻴﻠﻴﺎ ﺳﺒﻴﻮﻟﻔﻴﺪا‬

‫اﻟﺪآﺘﻮر ‪ /‬ﻓﺮاﻧﻜﻮ آﺎﻓﺎﻟﻲ‬

‫اﻟﺒﺮوﻓﺴﻮر ‪ /‬ﺟﻮن – ﺟﺎك زﻳﻤﺒﺮوﺳﻜﻲ‬

‫اﻟﺪآﺘﻮر ‪ /‬ﺑﻴﻦ أﻧﺪرﺳﻮن‬

‫اﻟﺪآﺘﻮر ‪ /‬أﻟﻴﻜﺲ أدﺟﻲ‬

‫اﻟﺪآﺘﻮرة ‪ /‬ﻓﺪوى ﻋﺘﻴﻘﺔ‬

‫اﻟﺪآﺘﻮر ‪ /‬راؤول رﻳﺒﻴﺮو‬

‫اﻟﺪآﺘﻮر ‪ /‬دﻳﻔﻴﺪ آﻴﺮ‬

‫اﻟﺪآﺘﻮر ‪ /‬ﻣﻮهﻴﺮا ﻟﻴﻨﺞ‬

‫اﻟﺪآﺘﻮر ‪ /‬ﻏﺴﺎن أﺑﻮﻋﻠﻔﺎ‬

‫‪Initiative to Improve Cancer Care in the Arab World ‬‬ ‫‪ ‬‬ ‫‪29 ‬‬ ‫‪ ‬‬

‫اﻟﺪآﺘﻮرة ‪ /‬ﺑﺎري ﺑﻠﻮﻓﻴﻠﺖ‬

‫اﻟﺪآﺘﻮرة ‪ /‬ﻟﻴﺰﻟﻲ ﻟﻴﻤﺎن‬

‫اﻟﺴﻴﺪة ‪ /‬آﺎﺛﻠﻴﻦ هﻮﻻهﺎن‬

‫اﻟﻬﻴﺌﺎت اﻟﻤﻨﻈﻤﺔ ‪:‬‬

‫ﻣﻨﻈﻤﺎت ﻣﺸﺎرآﺔ ‪:‬‬

‫‪ -1‬اﻻﺗﺤﺎد اﻟﺪوﻟﻲ ﻟﻤﻜﺎﻓﺤﺔ اﻟﺴﺮﻃﺎن )‪ . ( 2006‬إﻋﻼن اﻟﺴﺮﻃﺎن اﻟﻌﺎﻟﻤﻲ ‪ 25‬ﻣﺎرس ‪2010‬‬

‫‪Initiative to Improve Cancer Care in the Arab World ‬‬ ‫‪ ‬‬ ‫‪30 ‬‬ ‫‪ ‬‬

Name Title Institution Country

Name Email Contact Info

Human Resources Development

Name Title Institution Country

Objectives Action Steps Indicators Comments