Download Cancer in Saudi Arabia

Cancer in Saudi Arabia
BODY- Final
Abdul Aziz M. Hazazi
Cancer in Saudi Arabia
Student Name: Abdul-Aziz M. Al-Hazazi
PMU # 201100122
Section# 101
To: Dr. ALI Al-Ghazo
12/26/2012
Cancer in Saudi Arabia
Abstract
Cancer becomes one of the common diseases affecting people in the world. It has
many types and each one has its own symptoms and impacts. In particular, this research
paper will be focusing on Saudi Arabia. As in Saudi Arabia the breast cancer is the most
common type affecting females in Saudi Arabia. So, the purpose of my research is to
figure out “why the numbers of young people and women with cancer in the Kingdom of
Saudi Arabia have increased?” and what are the influences that lead to increasing in the
number of incidents. My methodology will be investigation technique as I have prepared a
survey which will be my reference to the findings in this research paper along with other
scientific research papers in the medical sector. I expect to find that cancer in women
and children is increasing in the Kingdom and due to lack of attention and follow-up is not
being properly treated.
Introduction
Cancer is a set of diseases that may affect different parts of the body. It affects the
cells and is not a transmissible disease. Greeks was the original innovator for this word
and they were the first one called this disease by cancer because of a similarity in fast,
progressive movement between the crab and cancer. All the human bodies consist of lots
of cells. Inside regular body’s cells grow, divide, and die in a well-ordered way during their
lifetime. Some of these cells in the body could grow out of control and this is because of
exterior or inner effects on the genetic constitution of a cell, when we get a collection of
these cells together, after that we will get a form that is called a tumor.
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Cancer in Saudi Arabia
Actually, I found this topic is worthwhile since it can increase my knowledge of the
issue which is very crucial to my country also one of my best friends passed away last
year because of cancer.
The purpose of this research is to determine the common types of cancer disease
in Saudi Arabia. Also to find out “why the numbers of young people and women with
cancer in the Kingdom of Saudi Arabia have increased?” Furthermore, in this research I
will be used my own survey result (Appendix 1) along with what other researches paper
have found relating to my topics and factors of cancer in Saudi Arabia.
Furthermore, the internet report presented by the Saudi Cancer Registry (2007)
shows that “It is clear from the report that the number and the incidence of cancer in
Saudi Arabia is on the rise”. Also, when take a look into this disease deeply we will find
the estimated number of cancer is 12,662,554 people in the worldwide. Of these, 56.1%
were in developing countries and 43.9% were in developed countries. There are many
types of Cancer that affect people in Saudi Arabia in particular; the most common cancer
among Saudi (all ages) is Breast Cancer and it ranked first, the total number of adult
cancer incidence cases reported was 11,437. Overall cancer was slightly more in females
than in males.
The Saudi Arabian Health System mainly is a public service, in which cancer care is
provided free of charge by the Ministry of Health (MOH) by many hospitals such as King
Faisal Specialist Hospital and Research Centre (KFSH&RC), and the university, armed
forces and national guard hospitals.
There has been a continuous and noticeable rise in the number of cancer cases in
the kingdom; however, this rise has not been in line with development in the medical
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Cancer in Saudi Arabia
services provided to the patients and their families by the hospitals. One of the essential
concerns about cancer in Saudi Arabia is Breast Cancer which accounts for around 30% of
all cancers identified worldwide and it is the fifth leading cause of all cancer deaths. In
Saudi Arabia in particular “Breast cancer represents the highest incidence among Saudi
females, accounting for 21.1% of all newly diagnosed female cancers”. (Dalal M. AlTamimi, MD et al., 2009). Another major Issue among patients with cancer in Saudi
Arabia is failure to attend medical appointments and loss to follow-up. These are obvious
issues and can affect their treatment and final result as well as can affect the allocation of
healthcare. These conditions can be divided into two parts first one is due to hospitalbased communication problems, and other one is due to errors in patient communication
with the hospital
Furthermore, the total number of cancer incident cases reported by Saudi Cancer
Registry was 12,309. It is very important to say that the main regions such as Riyadh,
Makkah and Eastern Province represent the most numbers of cases. This can be
predicated to the increasing number of people living/seeking medical care in these
developed cities with modern hospital facilities.
If there is lack of knowledge, attention about cancer as well as follow up is not
being properly treated and there is no development in the medical services offered to the
patients and their families by the Ministry of Health hospitals in Saudi Arabia, then this will
lead to a continuous and noticeable rise in the number of cancer cases between
(Women/Young) in Saudi Arabia.
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Cancer in Saudi Arabia
Body
In this research paper I will be focused to find out why the numbers of cancer
incidents are increasing among male & female (adult and children) in the Kingdom of
Saudi Arabia. Also, I will highlight the main reasons that make the number of cancer in
general increased especially with Breast Cancer. I have conducted a survey within Saudi
Aramco Cancer Treatment Center in Dhahran city, so this research paper will be based on
the responses and results from my survey questions comparing with what other research
papers have reached. This research paper will be divided into three significant sections
that are seem to be the main causes that affect people in Saudi Arabia. As cited in the
report presented by Saudi Cancer Registry (Haya S. Al-Eid., 2007) showed that "the entire
number of cancer incident cases reported to the SCR was 12,309". Generally cancer was
slightly more amongst women than men. Cancers affected 5,982 (48.6%) males and
6,321 (51.4%) females. “The five regions with the highest number of incident were
Riyadh Region, Tabuk Region Eastern Region, Makkah Region and Madinah Region”.
(Haya S. Al-Eid., 2007).
If we look at Breast cancer in particular, we will find that Breast cancer accounts
for about 30% of all cancers analyzed worldwide “Breast cancer represents the highest
incidence among Saudi females, accounting for 21.1% of all newly diagnosed female
cancers”. (Dalal M. Al-Tamimi, MD et al., 2009). It is the fifth most important cause of all
cancer deaths. In Saudi Arabia Breast cancer represents the highest incidence among
Saudi females, accounting for 21.1% of all recently identified female cancers. “Breast
cancer ranked in the first place and the total number is 1239 cases”. (Dalal M. Al-Tamimi,
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Cancer in Saudi Arabia
MD et al., 2009). Also, “the normal yearly age-standardized incidence rate amongst
Saudis was 65 per 100 000 between males and 68 per 100 000 among females, the highranking cancers among females, is breast cancer. (Hamdan NA, Ravichandran K and Dyab
AR., 1996). As a result, breast cancer ranked first among females and reporting for 26%.
Brest cancer was one of the main important part of my survey I have added three
significant question regarding breast cancer. The total participants in my survey were 46
people. I gave them three important questions will be discussed below as follows:
 Early detection of breast cancer increases survival?
 Females should practice Brest Self- Examination (BSE) regularly?
 Females must be educated about Brest Self- Examination (BSE)?
Based on these questions relating to the breast cancer it is noted that approximately 61%
of the participants were agreed in early detection of breast cancer incenses survival, but
around 39% answered by they don’t have any idea about this question. If early detection
of breast cancer will give them chance to live. Those who responses by they have no idea
about early dedication this shows us one of the main reason why we have a high number
in incidents of breast cancer in Saudi Arabia as they don’t have any idea if the early
detection can increase their survival or not. Moreover, the responses on the second
questions which is about the breast self-examination “should they practice breast selfexamination regularly or not” as this question will lead us to know if the female in Saudi
Arabia follow the right prevention of this cancer or not. It was clearly notedabout30%
says ‘YES’ and 70% they have no idea if they should make regular breast self-examination
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Cancer in Saudi Arabia
or they shouldn’t and around 10% they said ‘NO’ no need to do breast self-examination.
The third question was focused on the level of education of the breast cancer and I have
asked them “should the females be educated about Brest Self-Examination”?. Almost
100% of the participants they said ‘Yes. Females in Saudi Arabia are aware of the
dangerous of the breast cancer and they would like to have more info about it. In the
other hand when we look into other research papers have talked about Breast Cancer in
Saudi Arabia such as (Saulat Jahan et al.,2007) it showed that “Breast cancer is the most
common of all female cancers in Kingdom of Saudi Arabia”. As they conducted a survey
and they found “the knowledge of risk factors for breast cancer was about 76% of the
participants were capable to answer 3 or more (out of 7) questions correctly” (Saulat
Jahan et al.,2007). The basis of knowledge of breast cancer for majority of the
participants was from mass media. This result reveals lack of contribution of health care
labor force in health education of patients. Also in this study they find 30% of the
participants had received info about of Breast Self-Examination. “This percentage is not
high in comparison to like studies in Europe and the United States of America”
SaulatJahan et al.,2007) ,but it considered a higher number when compared with similar
studies carried out in Riyadh where 10.4%of the participants reported of being aware of
Breast Self-Examination. However, these findings in my survey result and other research
papers strongly suggest the need of education for proving accurate practice of Breast SelfExamination. The participants showed a negative attitude towards breast cancer Brest
Self-Examination education but they are willing to know and educate about the cancer
and follow the correct medical instruction. Thus, after the significant facts about breast
cancer we come up with that we should raise the level of awareness of the females in
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Cancer in Saudi Arabia
Saudi Arabia regarding breast cancer and Breast Self- Examination because it is not
satisfactory. The women showed a positive attitude towards learning this subject. On the
source of the results it is strongly suggested that there should be a well-designed health
education program for awareness of breast cancer and Breast Self- Examination for the
females in Kingdom of Saudi Arabia.
The second major reasons about why the numbers of cancers in Saudi Arabia are
increasing. It is basically involve on satisfaction towards the services provided by the
hospitals in Saudi Arabia. In my survey I have provided the participants with the below
questions and it will be discussed in this paper the questions where: Are you satisfied with the treatment provided to you by the hospital?
 Do you believe that you will find healthier treatment in US or Europe hospitals’?
As these questions were directed to 46 people most of them were getting their treatment
inside Saudi Aramco Treatment Cancer Center and a part of them from outside. The
majority of 59% responses indicate they are satisfied with the treatment provided by the
hospitals. That can be due to the professional level of medical treatments provided within
Saudi Aramco facilities. But, the remaining of 41% of responses was not satisfied and they
disagreed with the treatment provided by the ministry of health hospitals’. The majority
responses about the second question had shocked me as approximately 79% believed
that they will find healthier treatment in other country such as United States of America
and Europe hospitals. This indicate that they are not quite agree and not satisfied with
level of cancer care provided to them by the hospitals in the kingdom of Saudi Arabia
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Cancer in Saudi Arabia
especially the public and some private sector hospitals. However, when we look into other
research papers and analysis had prepared in this field it showed that there were an
analysis it was involved “85% of patients within Ministry Of Health hospitals; the remains
(15%) were achieved at other hospitals such as King Faisal Specialist Hospital, private
hospitals, military hospitals, and university hospitals” ”(AS Almuzaini ,1998). The level of
patient satisfaction towards the facilities and services delivered by these hospitals
specified that “69% of cancer patients who were accomplished at MOH hospitals were
dissatisfied and, likewise, 20% of those managed at other hospitals (all of them managed
at private hospitals) were not satisfied with the cancer care they received”(AS Almuzaini
,1998). Accordingly, as the highest number of patient dissatisfaction, which is around 84%
of the patients requested and were allowed to be transferred to non-MOH hospitals for
follow up and continuation of their care. As King Faisal Specialist Hospital in Riyadh
accepted more than 75% of them because it has the biggest specialized cancer care
center in the kingdom. Therefore, patients who were served and treated at King Faisal
Specialist Hospital, there were none of the patient testified dissatisfaction with the cancer
care provided. This means there is no specific standard that should be followed by the
hospitals that provide these services to the patients. And the ministry of health in Saudi
Arabia should force all the hospitals within Saudi Arabia to comply with these specific
standards and punished them if the break the rules. In the other hand, some research
showed that ”the Kingdom has also prepared a important investment in the teaching of
physicians. Most of the practicing oncologists in Saudi Arabia educated and trained in
North America.” (Dr. Abdul-Rahman Jazieh. 09 Feb 2012). This indicate that government
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Cancer in Saudi Arabia
knows they have to provide better health care to the patients in KSA to reduce the
number of cancer incidents by trained and qualified the doctors and hospitals staff.
The third section in my research paper is strongly linked to the above discussion and result
and it’s mainly concentrated about Failure to attend appointments and loss to follow-up and how
this can lead to increase the number of incidents cancer among male and females. As indicated in
my survey results about 93% of the participants they agreed to let their families informed about
their cancer. In the other hand, more than 69% responses represent the majority who disagreed
to make their friends informed about their illness and they will stop to visit the hospitals during
their appointments as they are afraid to see one of their friends out there. Also, there were a
study done by (BROWN S., BELGAUMI, 2009) showed that all of the patients with No Shows were
communicated, and reasons given for No Shows were classified. “Overall 340 No Shows cases,
34.1% were because of hospital-based communication errors, around 17.6% to errors in patient
communication with hospitals, about 7.4% were reported under transportation obstacles and
approximately 16.5% to further special personal reasons” (BROWN S., BELGAUMI, 2009) .
Reasons for No Show in all types were beneficial as to patients’ attitudes to treatment. However,
the occurrence of No Shows is overstated by clerical faults and could be reduced further by the
routine delivery of appointment cards and usage of mobile reminders. Furthermore, one of the
scientific researches about cancer care showed that “one of the main aspect of dealing with
cancer patients and their families involves communication. The research stated that good
communication is crucial at all stages of the cancer treatment steps, from showing and
analysis to palliative care”. (Dein, Simon.2011). Consequently, to reduce this problem an
innovative method whereby patients are, through their agreement, “reminded in advance of
potential hospital appointments by mobile is now in operation and seems to be working very
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Cancer in Saudi Arabia
effectively” (A. Ezzat 2007, pers. comm.). Nonetheless, failure to contact patients remains a
problem and may be even more interesting in developing countries where telephones are much
less accessible. This will remain as problem due to some patients have a lack of understanding
about the importance of follow-up. Growing use of local health personnel can be good solutions to
solve this problem and avoid arise on it as well as it will improve the awareness between the
patients.
Conclusion
As mentioned in the introduction of this research paper the thesis was if there is
lack of knowledge, attention about cancer and breast cancer in particular. Also, if follow
up is not being properly treated and there is no development in the medical services
offered to the patients and their families by the Ministry of Health hospitals in Saudi
Arabia, then this will lead to a continuous and noticeable rise in the number of cancer
cases between (Women/Young) in Saudi Arabia.
In Saudi Arabia Breast cancer represents the highest incidence among Saudi
females, accounting for 21.1% of all recently identified female cancers. “Breast cancer
ranked in the first place and the total number is 1239 cases”. (Dalal M. Al-Tamimi, MD et
al., 2009). The findings in my survey result and other research papers strongly suggest
the needs of an education for proving accurate practice of Breast Self-Examination. The
women in Saudi Arabia showed a positive attitude towards learning this subject. On the
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Cancer in Saudi Arabia
source of the results it is strongly suggested that there should be a well-designed health
education program for awareness of breast cancer and Breast Self- Examination for the
females in Kingdom of Saudi Arabia.
Moreover, the findings of this research paper in relation with the development in
the medical services offered to the patients and their families by the Ministry of Health
hospitals in Saudi Arabia. It was indicated that patients are not quite agree and not
satisfied with the level of cancer care provided to them by the hospitals in the kingdom of
Saudi Arabia especially the public and some private sector hospitals. Therefore, patients
who were served and treated at King Faisal Specialist Hospital, there were none of the
patient testified dissatisfaction with the cancer care provided. This means there is no
specific standard that should be followed by the hospitals that provide these services to
the patients. And the ministry of health in Saudi Arabia should force all the hospitals
within Saudi Arabia to comply with these specific standards and punished them if the
break the rules.
Also, one the outcomes of this paper were failure to attend appointments and loss
to follow-up will lead to increase the number of incidents cancer among male and females.
Overall 340 No Shows cases, 34.1% were because of hospital-based communication
errors, around 17.6% to errors in patient communication with hospitals, about 7.4% were
reported under transportation obstacles and approximately 16.5% to further special
personal reasons” (BROWN S., BELGAUMI, 2009)
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Cancer in Saudi Arabia
This research paper concludes that due to a lack of knowledge, attention about
cancer and breast cancer in particular. Also, due to the follow up is not being properly
treated and there is no development in the medical services offered to the patients and
their families by the Ministry of Health hospitals in Saudi Arabia, there are a continuous
and noticeable rise in the number of cancer cases between (Women/Young) in Saudi
Arabia.
References
BROWN, S.BELGAUMI, A.1. (May 2009). European Journal of Cancer Care: Failure to attend
appointments and loos to follow up: a prospective study of patients
with Malignant Lymphoma in Riyadh Retrieved from: EBSCO host database
Haya S. Al-Eid, BDS, DFE, CTR (2007) Cancer Incidence and Survival Report. Retrieved from
http://www.scr.org.sa/reports/SCR2007.pdf
Almuzaini, A.S.1 ( 1998) The attitude of health care professionals toward the availability of
hospice Services for cancer patients and their cares in Saudi Arabia. Retrieved from: EBSCO host
database
Saudi Cancer Registry (SCR) (1992) Retrieved from http://www.scr.org.sa/index.php?lang=en
Al-Tamimi, Dalal M.1 Jul/Aug2009 Distribution of Molecular Breast Cancer Subtypes in Middle
Eastern-Saudi Arabian Women. Retrieved from: EBSCO host database
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Cancer in Saudi Arabia
Hamdan NA, Ravichandran K and Dyab AR, (1996) Breast cancer survival in Riyadh, Retrieved
from World Health Organization (International Agency for Research on Cancer retrieved from:
http://survcan.iarc.fr/survival/chap23.pdf
Saulat Jalian, Abdullal, M. Al-Saigul, and Muzamil H. Abdelgadir, (2006) Breast cancer
Knowledge, attitudes and practices of breast self-examination among women in Qassim region of
Saudi Arabia Retrieved from: http://ipac.kacst.edu.sa/eDoc/2006/160858_1.pdf
Dr. Abdul-Rahman Jazieh. (09 Feb 2012). Cancer Care in Saudi Arabia: An interview with
International Affairs Committee member Abdul-Rahman Jazieh, MD, MPH. Retrieved from:
http://connection.asco.org/Magazine/Article/ID/3141/Cancer-Care-in-Saudi-Arabia.aspx
Dein, Simon (2011). Culture and Cancer Care. Berkshire, GBR: McGraw-Hill Professional Publishing,
Retrieved from http://site.ebrary.com/lib/pmu/Doc?id=10161359&ppg=68
Appendix
Basically this survey was held inside my company exactly in Saudi Aramco Cancer
Treatment Center in Dhahran. Also 3 people from my family were included as they have
suffered from Cancer. Total participant patients in this survey were 46 persons including
(Male & Female). I have divided this survey into two parts one was designed only for
females and other one for both male and female.
Tables below illustrate the figures that have been produced from this survey. Figures will
be used in my research paper which is about Cancer in Saudi Arabia.
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Survey Summary
Almost all participants agreed to know all details about their illness approximately
95%, however, around 69% of the participants were disagreed of informing their friends
about their illness. As clearly definite during the survey nearly 86% of participants were
agreed to know all side- effect of the treatment, in the other hand, around 41% were not
satisfied with the treatment and healthcare provided to them by the hospital and it’s worth
noting approximately 79% they are believing they will find healthier treatment in US and
Europe hospitals better than treatment in hospitals inside KSA.
The second part of the survey was intended only for females regarding to Breast Cancer.
As specified in the second table around 39% they don’t have any idea about an early
detection of breast cancer. Indeed, all the participants from females were agreed by
100% regarding females must be educated about Brest Self- Examination.
Variables
Do you want to know all the
information about your illness (Cancer)?
Do you want to know only partial
information about your illness?
Should we tell your family?
Should we tell your friends?
Should we treat you without telling you
Response
o Agree
o Neither agree nor disagree
o Disagree
Participants Number
%
44
95%
0
0%
2
5%
5
9%
0
0%
41
91%
o Yes
o NO
43
93%
3
7%
o Yes
o NO
14
31%
32
69%
7
15%
o Agree
o Neither agree nor disagree
o Disagree
o Agree
o Neither agree nor disagree
Cancer in Saudi Arabia
o Disagree
about the effect of the treatment?
Should we treat you without telling you
about disease if it proves to be cancer?
o Agree
o Neither agree nor disagree
o Disagree
o Agree
o Neither agree nor disagree
o Disagree
Do you want to know all side-effect of
the treatment?
o Agree
o Neither agree nor disagree
o Disagree
Are you satisfied with the treatment
provided to you by the hospital?
Do you believe that you will find
healthier treatment in US or Europe
hospitals’?
o Agree
o Neither agree nor disagree
o Disagree
15
0
0
39
85%
0
0
0
0
46
100%
40
86%
0
0%
8
14%
27
59%
0
0%
19
41%
36
79%
3
7%
6
14%
These questions offered only to FEMALS regarding to (Breast Cancer):
Variables
Response
Early detection of breast cancer
increases survival?
o
o
o
YES
I Have No Idea
NO
Females should practice Brest SelfExamination (BSE) regularly?
o
o
o
YES
I Have No Idea
NO
Females must be educated about Brest
Self- Examination (BSE)?
o
o
o
YES
I Have No Idea
NO
Participants Number %
8
5
0
4
9
0
13
0
0
61%
39%
0%
30%
70%
0%
100%
0%
0%
Cancer in Saudi Arabia
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