Middle East Cancer Consortium Research Articles

Middle East Cancer Consortium-Development of Palliative Care Services for Cancer Patients.

When patients are diagnosed with cancer, they lose the mode of living they have been accustomed to and face difficulties in coping with the new complexed medical condition. In the case of advanced stages of cancer, patients lose the ability to take an active role in decisions related to priority in treatment modality, decision-making, and planning. In addition, these patients lose the ability of choice-to agree to a certain mode of treatment, who will treat them, and where. Thus, these kinds of decisions are between family members and the treating team. This can happen only when both the formal caregivers and to lesser degree the informal partners are exposed to ongoing educational activities and training by both local experienced palliative care experts and international initiated courses (both frontal and remote). This article provides recommendations needed for an effective strategy at national levels to develop appropriate ways, whereby governmental agencies and non-governmental organizations can promote the establishment of palliative care services at all levels from primary to tertiary in each individual country. The basis for the above will rely on the experience that was gained through the application of palliative care principles.

Amasya ilinde 2013-2017 yılları arasında bildirimi yapılan kanser olgularının klinik ve epidemiyolojik özellikleri

Objective: In order to determine the region-specific risk factors of cancers, it is necessary to examine the distribution according to the characteristics of person, place and time. In the current study, it was aimed to determine the distribution of cancer diagnoses reported between 2013 and 2017 in Amasya province and these diagnoses in terms of clinical features and various sociodemographic variables.
 
 Methods: The population of this descriptive study was composed of the cases who were diagnosed with cancer, which the Middle East Cancer Consortium deems necessary to be reported, in various health institutions between 2013 and 2017 and were registered in the Cancer Registry Center. The codes in ICD-O-3 were used in the classification of cancer diagnoses. In order to eliminate the confounding effect of the age variable in the presentation of cancer rates, age-standardized rates were calculated using the World Standard Population. 
 
 Results: The three most common cancers between 2013 and 2017 were trachea/bronchus/ lung, colorectal and stomach cancers. The three most common cancers in men were trachea/ bronchus/lung, prostate and stomach cancers. This was ranked as breast, colorectal and thyroid cancers in women. It was found that between 2013 and 2017, age-standardized rates of all cancers were found to increase from 151.3 to 184.1 per 100,000 population. 
 
 Conclusion: The incidence rate of all cancers for both genders between 2013 and 2017 is below Turkey’s average. Gastrointestinal system malignancies, especially gastric cancer, have an incidence rate higher compared to Turkey for both genders. Intervention studies should be planned using the results of the current study.

The Middle East Cancer Consortium: A Model for Regional Conciliation and Compassion in the Middle East

Regions in the Middle East are still experiencing political and military hostilities which negatively affect the health and health services of millions of people. Cancer is one of the major causes of high morbidity and mortality in the region. Palliative care for the cancer patient is one of the care options available for all those suffering from such a life-threatening disease. The Middle East Cancer Consortium (MECC) initiated a regional plan to implement palliative care approaches both in hospitals and the community. Moreover, the region lacks experienced professionals who could pave the way for establishing national palliative centers and guide primary care physicians and nurses to exercise this relatively new discipline in clinical practice. This report describes, in short, the endeavors, barriers and successes of this project, which are intended to bring medical professionals closer, thereby promoting understanding, respect and tolerance among individuals and communities in conflict.

Modeling the pathway of breast cancer in the Middle East

Abstract This paper proposed an approach for the identification of mutation mechanisms of breast cancer in women in four member countries of the Middle East Cancer Consortium i.e. Egypt, Jordan, Cyprus and Israel (Arabs and Jews). We set up multistage models including both gene mutation and the clonal expansion of intermediate cells. We fit the data-set related to the incidence of female breast cancer in the four member countries. Our simulation results show that the maximum number of driver mutations of breast epithelium stem cells of Egyptian women is 13, whereas there are 14 driver mutations in the genome of stem cells of female patients in Jordan, Cyprus and Israel (Arabs and Jews). In addition, the 3, 10, 5, 5 and 4 stage models are the optimal ones for the tumorigenesis of females in Egypt, Jordan, Cyprus, Israel (Arabs) and Israel (Jews), respectively. The genomic instability is caused by first three driver mutations.

The need for a universal language during the COVID-19 pandemic: Lessons learned from the Middle East Cancer Consortium (MECC).

The need for a universal language during the COVID-19 pandemic: Lessons learned from the Middle East Cancer Consortium (MECC).

Surveillance for Jordan Cancer Burden: Jordan Cancer Registry Data 2010-2014

Background: Cancer registry is an important tool for any successful cancer control program. The cancer-related data from Jordan was vague scarcity. This, urged scholars to set up the first and only population-based cancer registry in Jordan. Which did the Ministry of Health and the Middle East Cancer Consortium (MECC) established it jointly. The registry started to collect data from cases of cancer referred to the treatment and diagnostic facilities throughout the country to improve cancer reporting in the country and define the size of the cancer problem and the pattern of cancer in Jordan; distribution of cancer by geographical locations; age; gender; type and cancer sites for both Jordanians and non-Jordanians. Strategy/Tactics: The Jordan Cancer Registry (JCR) collects cancer data in passive and active methods of case finding, the collected data coded by means of ICD_O3. Quality control measures applied, and the data stored and computerized using CanReg_4 and CanReg_5; then analyzed statistically. World standard population for age adjustment and standardization to facilitate national and international comparison and contrast. Outcomes: Incidence of the most common cancers among Jordanians, distributed by site, age, gender, and geographically for the period 2010-2014. The leading cancer among adults, males was colorectal (11.9%) followed by lung (11.7%), leukemia (9.1%), urinary bladder (8.9%) and prostate (8.1%). While among female cancers are breast (34.4%), colorectal (9.4%); leukemia (6.7%); lymphomas (5.8%) and thyroid (5.3%). Childhood cancers were about (4.9%) of all cancers; leukemia was 1st (34.8%) followed by brain and CNS (20.9%) and lymphomas (17.5%). Whereas the most recent mortality data showed lung is responsible for (21.03%) deaths among males followed by colorectal (11.0%) and leukemia (8.02%). Among females breast deaths (26.8%); colorectal (9.3%) and leukemia (7.2%). What was learned: Knowledge to action, based on the JCR data, Jordan started the Jordan Breast Cancer Program for early detection and screening of breast cancer. We are looking forward starting early detection for colorectal cancer soon.

Training for awareness of one's own spirituality: A key factor in overcoming barriers to the provision of spiritual care to advanced cancer patients by doctors and nurses.

When patients feel spiritually supported by staff, we find increased use of hospice and reduced use of aggressive treatments at end of life, yet substantial barriers to staff spiritual care provision still exist. We aimed to study these barriers in a new cultural context and analyzed a new subgroup with "unrealized potential" for improved spiritual care provision: those who are positively inclined toward spiritual care yet do not themselves provide it. We distributed the Religion and Spirituality in Cancer Care Study via the Middle East Cancer Consortium to physicians and nurses caring for advanced cancer patients. Survey items included how often spiritual care should be provided, how often respondents themselves provide it, and perceived barriers to spiritual care provision.ResultWe had 770 respondents (40% physicians, 60% nurses) from 14 Middle Eastern countries. The results showed that 82% of respondents think staff should provide spiritual care at least occasionally, but 44% provide spiritual care less often than they think they should. In multivariable analysis of respondents who valued spiritual care yet did not themselves provide it to their most recent patients, predictors included low personal sense of being spiritual (p < 0.001) and not having received training (p = 0.02; only 22% received training). How "developed" a country is negatively predicted spiritual care provision (p < 0.001). Self-perceived barriers were quite similar across cultures.Significance of resultsDespite relatively high levels of spiritual care provision, we see a gap between desirability and actual provision. Seeing oneself as not spiritual or only slightly spiritual is a key factor demonstrably associated with not providing spiritual care. Efforts to increase spiritual care provision should target those in favor of spiritual care provision, promoting training that helps participants consider their own spirituality and the role that it plays in their personal and professional lives.

Refugees in Conflict: Creating a Bridge Between Traditional and Conventional Health Belief Models.

European oncologists face a communication gap with refugee patients who have recently immigrated from Middle Eastern and northern African countries, with their different health belief models and affinity for traditional and herbal medicine. A culturally sensitive approach to care will foster doctor-refugee communication, through the integration of evidence-based medicine within a nonjudgmental, bio-psycho-social-cultural-spiritual agenda, addressing patients' expectation within a supportive and palliative care context. Integrative physicians, who are conventional doctors trained in traditional/complementary medicine, can mediate between conventional and traditional/herbal paradigms of care, facilitating doctor-patient communication through education and by providing clinical consultations within conventional oncology centers.

Lung Cancer Incidence Patterns in Four Countries of the Middle East Cancer Consortium (Cyprus, Jordan, Israel, Izmir (Turkey)) with Comparison to the United States Surveillance, Epidemiology and End Results (SEER) Program

Lung Cancer (LC) is the leading cause of cancer death worldwide. LC incidence data from four Cancer Registries of the Middle East Cancer Consortium (Cyprus, Israel, Izmir/Turkey and Jordan) are reported with the aim to examine the differences between these four countries and SEER. Cancer registry data on invasive lung cancer diagnoses for 2005-2010 were analyzed. Age-Standardized incidence Rates (ASR) and age distribution were calculated. The percentage of microscopically verified cases, the histological type and staging of the disease were also captured. There is a greater than 4-fold difference in the total ASR for LC between Izmir/Turkey (51.6) and Jordan (11.6), whilst Cyprus (20.8), Israel Jewish (24.3) and Israel Arab (30.7) have intermediate ASRs. A much lower incidence was observed for women in the MECC countries compared to SEER (37.5), with Israeli Jews having the highest incidence (16.4). For men, both Turkey (98.0) and Israel Arab (54.3) have higher ASRs than SEER (52.5), whilst Jordan has the lowest (19.1). There is a larger proportion of adenocarcinoma in Cyprus and Israeli Jews, and of squamous cell cancer in Turkey. The proportion of patients with metastatic disease is between 52-60.8% for Cyprus, Israel, Izmir Turkey and SEER, but higher at 71.1% in Jordan. Despite the close geographic proximity there are significant differences in LC incidence rates, age distribution, histological types and staging in the four MECC countries that need to be taken into consideration in the design of cancer control and prevention activities in these countries.

Cancer burden in four countries of the Middle East Cancer Consortium (Cyprus; Jordan; Israel; Izmir (Turkey)) with comparison to the United States surveillance; epidemiology and end results program

It is important that population-based cancer registries provide accurate and reliable data for public health purposes. These data are essential data for planning of cancer control and prevention. In this study, we examined cancer incidence rates (year 2005–2010) in four MECC registries (Cyprus, Jordan, Israel, Izmir (Turkey)) and compared with the rates in the US. The overall age-standardized incidence rates for males were highest in the US followed by Israeli Jews, Izmir (Turkey), Cyprus, Israeli Arabs, and lowest in Jordan. In women the rates of cancer of all sites were also highest in US women followed by Israeli Jews, Cyprus, Israeli Arabs, Izmir (Turkey), and lowest in Jordan. It is of interest that although site-specific cancer rates differ between the countries studied, prostate, lung and colorectal cancers are within the five most common cancers males in all countries studied. In females, breast colorectal and endometrium cancers are three of the five most common cancers in females in all countries studied. The results presented in this paper can have implications for opportunities in cancer control and prevention in these countries. Future studies on individual cancer sites with highest rates in these Countries are currently underway.

Community Palliative Care in Turkey: A Collaborative Promoter to a New Concept in the Middle East.

The Middle East has been struggling with basic issues of cancer care, and in specific, palliative care, at the primary health care level in the communities. The Middle East Cancer Consortium designated this issue as the highest priority of its activities in the region. Following basic and advanced courses and national and international workshops, local governments recognized the essentiality of developing palliative care services in their respective countries. As the result of these training activities, in 2010, the Ministry of Health in Turkey initiated a novel program whereby population-based and home-based palliative care teams were developed throughout the country, including peripheral regions in the countries where appropriate care was not available. This initiative led to a dramatic increase in the number of cancer patients receiving palliative care at their homes. The Turkish initiative can serve as a model to other countries in the Middle East and beyond it.

411P Palliative care in Egypt: the experience of the Gharbiah Cancer Society

Aim/Background: The need for palliative care in middle and low resources countries, including Egypt, is emerging.The Gharbiah Cancer Society (GCS) is a nonprofit, nongovernmental hospital, located in Tanta, the Capital of the Gharbiah governorate in the mid-Nile Delta. The Society provides acute care to patients with cancer including surgery, chemo-, and radiotherapy. Review of 9 year-data of Gharbiah population-based cancer registry from 1999 to 2007 revealed 3480 cancer cases/year, with Age Standardized Rate (ASR) of 161.7/100,000 for males & 120.8/100.000 for females. About 70% of cases present in advanced stages (III&IV) with liver cancer the most frequent cancer in male and breast cancer as the most frequent cancer in females. The GCS started a comprehensive palliative care services in April 2011 with 10-bed inpatient unit and 6 days/week outpatient clinic. All palliative care equipment were provided by public donations. Methods: Through collaboration with National Cancer Institute, Bethesda, Maryland and the San Diego Hospice and the Institute for Palliative Medicine and Middle East Cancer Consortium, a fellowship training program was developed for a medical oncologist in palliative medicine and End-of-Life Care training course for nurses. Results: The program succeeded in convincing local health authorities to increase the recommended opioids dose and to allow more physicians to prescribe opioids for cancer pain. In a period of 36 months, symptom management and palliative care were provided to 290 patients with advanced malignancies. Conclusions: The Major challenges for the program were inadequate public and health professionals awareness of palliative care services and lack of vehicles and finances to cover home visits. The initial results of the program warrant allocating more resources for coverage of a large number of trainees and instituting a home visits program. Disclosure: All authors have declared no conflicts of interest.

The Fight against the “Human Disaster” of Cancer in the Middle Eastern Countries

An important example of such efforts is the International Palliative Care Conference sponsored by Turkey’s Health Ministry in Ankara during April 2-4, 2014, highlighting the Turkey’s 13th National Cancer Awareness Week. Organizing bodies were the Middle East Cancer Consortium (MECC), in collaboration with the Oncology Nursing Society (ONS), the National Cancer Institute (NCI), and the American Society of Clinical Oncology (ASCO). More than 70 participants from the following countries attended the conference: United States of America, Egypt, Iran, Iraq, Israel, Jordan, Lebanon, Pakistan, Palestinian, Qatar, Kingdom of Saudi Arabia, Sudan, Sultanate of Oman, Turkey, United Arab Emirates and Yemen.

Integration of complementary medicine in supportive cancer care: survey of health-care providers’ perspectives from 16 countries in the Middle East

In this multinational Middle-Eastern study, we assessed health-care providers' (HCPs) perspectives on their patients' use of complementary and traditional medicine (CTM) and identified the leading barriers to CTM integration in supportive cancer care. A 17-item questionnaire was developed and administered to HCPs attending palliative medicine workshops conducted across the Middle East by the Middle East Cancer Consortium. 339 HCPs from 16 countries across the Middle East completed the questionnaire (80.3 % response rate). Respondents perceived their patients' reasons for CTM use primarily in the context of cancer cure (63 %) and quality of life (QOL) improvement (57 %). Expectation regarding CTM's role in cancer cure/survival was more pronounced in Turkey, Jordan, the Palestinian Authority, and the Persian Gulf area. In contrast, the expectation that CTM would improve QOL was more emphasized in Israel. A mid-position between the cure/survival and QOL poles was observed in Cyprus, Lebanon, and the North African countries. Leading barriers to CTM integration in supportive cancer care included oncologists' skepticism and a gap between patients' expectations and HCP's objectives. Respondents' leading recommendation to HCPs was to communicate integrative care emphasizing well-being and improved functioning in accordance with their patients' health beliefs. CTM integration in supportive cancer care can be facilitated by implementing a platform for Middle Eastern clinical collaborations. HCPs' expectations and experiences with CTM have been positive in the oncology setting. These data need to be corroborated with information of patients' expectations on the provision of CTM over all phases of the oncology treatment.

Palliative Care and Nursing in Palestine, 2015

As cancer is the second leading cause of death in Palestine (14.2%), and as it is diagnosed usually in the late stage, this makes its burden heavier on both patients and the healthcare system, and leads to poorer quality of life (QoL) of patients. This leads to great need initiate and implement palliative care (PC) to improve patients QoL. PC nursing is on the priority within such endeavors, which is still in its early development and needs national and international support. On the clinical aspect, only one PC team, composed of a nurse and a social worker, is implementing PC consultations in Bethlehem, depending on minor support from local community. On the other hand, opioids are still under prescribed by limited number of physicians only, with no access of nurses to prescription or modification. Hospice service or nurses are not available yet in the country. Knowledge of PC and its importance is limited among nurses, as well as other healthcare professionals, in Palestine. There is a new initiative to include PC education in the curriculum of undergraduate nurses in the governmental education in the ministry of health, but still no official programs in PC yet. Nevertheless, there are some workshops in PC conducted by the Middle East Cancer Consortium and AL-Sadeel Society. Even though, limited researches done in Palestine suggest a positive attitude of Palestinian nurses toward PC and willingness for its education. Needs for development of PC include, after adopting supporting legislations and policies within the national system, proper PC training and certification, public awareness, and formation of PC teams. Future outlooks include initiating educational programs in palliative care nursing at the undergraduate and post graduate levels, integrating PC into the national health plans and education, valuing competent palliative care, and more national and international concerns and funds for those struggling to initiate PC in Palestine.

Nurses Paving the Way to Improving Palliative Care Services in the Middle East

Copyright: © 2013 Silbermann M, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. In January 2012, the Ministers of health of the Gulf Cooperation Council (GCC) met in Muscat, Oman to respond to the UN General Assembly Political Declaration on the Prevention and Control of NonCommunicable Diseases (NCDs) [1]. “The regional strategy details what the six (GCC) countries will be doing to tackle NCDs during the next years in terms of reducing people’s exposure to causative risk factors and improving services to prevent and treat these leading health problems”, said Dr. Ahmed Al-Saidi, Omani Minister of Health who chaired the meeting [2]. One month later, MECC together with the Oncology Nursing Society (ONS) and the Omani National Association for Cancer Awareness (NACA) organized the first palliative care course for Omani nurses [3]. As a direct follow up to that course earlier in February this year, the Middle East Cancer Consortium (MECC) jointly with the Oman Cancer Association (OCA), the Oncology Nursing Society (ONS), the National Cancer Institute (NCI) and the American Society of Clinical Oncology (ASCO) organized an advanced training course in palliative care for nurses which was followed by a research day on palliative care in the community and an international workshop on palliative care for the geriatric oncology patient. Over 600 attendees from the following countries took part in these events: USA, Egypt, Jordan, Palestine, Israel, Cyprus, Turkey, Iraq, Pakistan, Morocco, United Arab Emiratis, Saudi Arabia, Lebanon, Qatar, Yemen, Sudan, France and Oman.

Promoting Mutual Tolerance, Respect and Understanding through Cancer Palliation

Last week I was privileged to organize a Pediatric Palliative Care Workshop of the Middle East Cancer Consortium (MECC) in Larnaca, Cyprus, that brought together health-care professionals from Turkey, Cyprus (both Greek and Turkish parts), Saudi Arabia, Jordan, Lebanon, Palestine, Iraq, Pakistan, Morocco and Uganda. This forum meets every year in Cyprus to explore the best ways to alleviate the suffering of cancer victims. It is inspiring. Universal empathy for the terminally ill and the dying breaks through political walls and overpowers religious and cultural differences. The dominant language in the meeting is that of compassion, solidarity and human decency. Such a gathering calls for hope where geopolitical conflicts rule, for the building of bridges to common ground[1]. The faculty from the United States described the most recent advances in palliative care, whereas the participants from the Middle East exalted the role of the extended family as an important companion of the dying during their final journey. The familiarity with death, which is decreasing in developed countries, produces a unique appreciation of the gifts of life and of the sacredness of each human being endowed with a special mission for which no advanced technologies can stand in[2].

Middle East Experience in Palliative Care

Palliative Care (PC) is still a relatively new concept in the Middle East (ME). It was first introduced in Saudi Arabia in 1992 and only recently in countries such as Qatar, Bahrain, and the UAE. Although the majority of Middle-Eastern countries, including Palestine, Iraq, Oman and Lebanon are in the capacity building phase, others such as Saudi and Jordan already have localized provision. In the absence of any of the ME countries approaching integration with the mainstream service providers, Saudi Arabia and Jordan are currently setting examples of achievement in the field. There are still countries with little or no known Palliative Care activity (Yemen and Syria). Political issues, scarcity of resources, and lack of education and awareness seem to be the common factors restricting the progress of this field in most countries. In order to improve the suboptimal PC services in the ME, emphasis should be directed toward providing formal education to professionals and raising awareness of the public. It is also necessary to put all differences aside and develop cross-border collaborations, whether through third party organizations such as the Middle East Cancer Consortium (MECC) or otherwise. This review compiles the available literature on the history and progress of the field of PC in most ME countries, while pointing out the major obstacles encountered by the active parties of each country.

Palliative cancer care in Middle Eastern countries: accomplishments and challenges

In larger parts of the Middle East palliative care is still misunderstood among health professionals, cancer patients and the public at large. One reason to that is because the term does not obviously communicate the intent of this clinical discipline, which is lending better quality of life while combating cancer. Further, culture, tradition and religion have contributed to this misgiving and confusion especially at the terminal stage of the disease. The Middle East Cancer Consortium jointly with the American Society of Clinical Oncology, the American Oncology Nursing Society, the San Diego Hospice Center for Palliative Medicine and the Children's Hospital & Clinics of Minnesota initiated a series of training courses and workshops in the Middle East to provide updated training to physicians, nurses, social workers and psychologists from throughout the region with basic concepts of palliative care and pain managements in adults and children cancers. During the past 6 years hundreds of professionals took part in these educational and training activities, thereby creating the core of trained caregivers who start to make the change in their individual countries. The outcome of consecutive training activities can overcome geopolitical instabilities, and yield a genuine change in approach of both regulators, medical administrators, medical staff and the public; as to the important contribution of palliative care services to the welfare of the patient and his/her family.

Complementary and Integrative Oncology in the Cross-Cultural Region of the Middle East and South Asia

Complementary and Integrative Oncology in the Cross-Cultural Region of the Middle East and South Asia