Cancer Survivorship in Gulf Countries: An Updated Systematic Review
Authors: Hameed Maha , Garcia Gustavo , Yaseen Laiba , Sohail Iman , Effendi Iqra , Amin Asad , Ashraf Aqsa , Anwer Faiz , Faisal Muhammad Salman 
Published: December 2023

Introduction
Cancer survivorship addresses attendant challenges beyond treatment, emphasizing outcomes of patient quality of life, costs, emergency services/hospitalization, and mortality. Nekhlyduov L et al., 2019 describe nine domains of cancer survivorship which, although represented distinctly, are interrelated and codependent. Despite the sustained worldwide increase in the burden of cancer in the past decade, there is a paucity of evidence regarding cancer survivorship pertaining to patient needs across the Gulf countries.
Methods
A systematic review adhering to the PRISMA 2020 guidelines was conducted to assess cancer survivorship across the 6 Gulf countries Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates. We utilized search results across Medline, Embase, Cochrane, SciELO, and Web of Science published in English through April 1, 2023. Our search terms were inclusive of the country's names, cancer, survivors, neoplasm, survivorship, and follow-up studies were used. Included articles were then evaluated for nine domains of cancer survivorship outlined by Nekhlyduov L et al., 2019.
Results
Thirty-one articles were included in the systematic review. Cancer survivorship in the context of hematological malignancy (leukemia, lymphoma, and multiple myeloma) was observed in 48% (n = 15) of studies. Saudi Arabia accounted for most of the published literature, 67.7% (n = 21). Kuwait, Qatar, and Bahrain all reported the least on cancer survivorship, 3.2% (n = 1). Clinical structure, surveillance, and management of physical and psychosocial effects were the most reported domains across the included articles, 87.1% (n = 27), 74.2% (n = 23), and 67.7% (n = 21), respectively. Conversely, the surveillance and management of chronic medical conditions and patient and caregiver experience domains were the least reported,12.9% (n = 4) and 9.7% (n = 3), respectively.
The clinical structure domain refers to the type of healthcare delivery environment, cancer survivorship providers' education and training status, availability, and access to needed specialty care, healthcare professionals, health information systems, and opportunities for research participation to patients. The surveillance and management of physical and psychosocial effects domains encompassed assessment of patient symptoms and conditions, referral of recommended evaluation, recommendations of and adherence to appropriate treatment and risk-reducing strategies, and reassessment of symptoms and/or conditions at defined intervals and/or treatment phases. The domain of surveillance and management of chronic medical conditions involves evaluating and treating noncancer comorbidities using disease-specific indications and medical reconciliation. The patient and caregiver experience domain assesses the patient's satisfaction with the healthcare provider, perceived timely access to healthcare and services, and follow-up regarding test results.
Conclusion
Our findings siren the need for a clear focus on the clinical structure domain. There are significant gaps in both the countries reporting on the topic and the domains of cancer survivorship included in their studies. Importantly, Oman, Kuwait, Qatar, and Bahrain require further cancer survivorship research. Moreover, all the countries need to emphasize domains of surveillance and management of chronic conditions and patient caregiver experience.