Cancer research in vulnerable populations: A call for collaboration and sustainability from MENATC countries.
Authors: Tolba Marwan Abdelwadod , Fadhil Ibtihal , Al-Zahrani Ali , Abdul Sater Zahi , Skelton Mac , Kutluk M. Tezer , Akbarov Kamal , Taher Ali , Sullivan Richard , Mula-Hussain Layth Y.I. 
Published: June 2023

e13649 Background: Cancer is a major burden across the Middle East and North Africa including Turkey and Cyprus (MENATC). Many MENATC countries experience acute and chronic emergencies, including COVID-19 pandemic, disasters, political instability, fragility, as well as chronic conflict that result in cumulative vulnerability to the region. This study examines the current level and the potential for cancer research among vulnerable populations in the MENATC, including its challenges, and gaps. Furthermore, it tries to ascertain cancer practitioners’ views on what defines vulnerability in the MENATC. Methods: Recurrent expert-driven meetings were held to conceptualize the study approach and highlight the barriers to conducting clinical cancer research among vulnerable populations in the MENATC. A self-administered online survey questionnaire was circulated to over 500 cancer practitioners in twenty-three MENATC countries. The survey covered: Demographic and general information, Clinical practice, Research capacity, Vulnerable populations, and logistics. Results: Half of the respondents considered clinical research in vulnerable cancer patients a key concern, while 24.5% did not. Out of the total respondents, 21.8% had worked on research that explicitly included vulnerable populations. About 60% of respondents reported seeing vulnerable populations during their daily practice. Lack of funding (60%), lack of protected time (42%), and lack of research training (35%) were the top three main reasons for research scarcity and major research challenges. Over half of the respondents agreed that recent wars/conflicts worsened the conditions for vulnerable populations. The top five ranked vulnerability groups were geriatric, terminally ill, mental health-related, chronically ill, and socioeconomically deprived patients, while the lower five ranked groups were LGBTQ+ community, veterans, divorced individuals or widowed women, prisoners, and ethnic minorities patients. Conclusions: This is the first study in the MENATC region to look at the status of and potential for research among vulnerable populations. The study highlights the challenges faced by cancer practitioners in the MENATC in research, especially among vulnerable populations. We believe that these limitations in research will negatively impact the outcomes for vulnerable communities in the region. Lack of research funding and training of cancer practitioners in the MENATC are major factors negatively affecting cancer outcomes which could lead to health improvement failure. Geopolitical, economic, and cultural differences clearly define the most vulnerable populations in cancer research. Addressing cancer disparities in the MENATC is a complex and pressing issue. By working together and providing the necessary resources, we can improve cancer research outcomes for the most vulnerable populations in the region.