21.1 Background

The editors of the book contacted authors to write book chapters on cancer care outlook for their respective Arab countries. Every including Arab country in the book has agreed on unanimous effort to bring forward this worthwhile project. However, the editors were unable to find the authors for Qatar, Comoros, and Djibouti. Hence, they decided to compose a short review on oncology care in the aforementioned countries for the book.

21.2 State of Qatar

21.2.1 Introduction

The Arabian Peninsula encompasses a ministate, the State of Qatar, with a small-scale, comparable young national population. Moreover, it has an extensive ratio of the expatriate population. The country has observed rapid advancement over the last few decades. Subsequently, it has a high per capita Gross Domestic Product (GDP). Cancer has been ranked second among Non-Communicable Diseases (NCDs) in Qatar, first being cardiovascular diseases (CVD). The cancer projection has been estimated to be at threefold elevation between 2010 and 2030, compounded by advanced age and population growth [1].

Qatar has free public health care services, including cancer care for its residents who have paid a minimum health insurance cost. Few charities, including Qatar Cancer Society (QCS) provide accessible ad hoc assistance for cancer treatment on exceptional or humane grounds. The healthcare infrastructure has observed major progress since the launch of the National Cancer Strategy in 2011. Qatar has a formal structural plan and internationally peer-reviewed cancer care services that deliver outcomes proportional to those countries who are ahead in established comprehensive cancer care structures. This has translated into a high assurance level for cancer care services among the population. Hence, substantially increased usage of oncology services can be observed mostly by natives [1].

21.2.2 Oncology Care in the State of Qatar

Qatar has advanced administrative authorities to supervise the strategies, including, a National Cancer Committee that comprises representatives from all sectors to monitor the progress with the established framework (Fig. 21.1) [1].

Fig. 21.1
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Oncology care strategies framework [1]

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21.2.3 Advanced Technology and Breakthroughs in Cancer Care

Qatar’s investments in healthcare infrastructure and advanced technologies have improved the clinical practice along with upgraded cancer care facilities across the country. A few top-notch cancer care services available in Qatar are mentioned below [1]:

  • Specialist Palliative Care Unit: A ten-bedded facility has opened the door for a cancer center. This establishment has been approved to offer an accredited fellowship training program.

  • Radiotherapy: Qatar’s healthcare system comprises many ultra-modern treatment modalities apart from conventional radiotherapy services; subsequently, improved patients’ outcomes can be observed. These contemporary technologies, include Cyberknife, MRI guided High Intensity Focused Ultrasound (MRgHIFU), Magnetic Resonance Image Guided Adaptive Brachytherapy (MR-IGABT), Radiation Therapy Surface Guided Radiotherapy (SGRT), Total body irradiation (TBI), and Cyclotron.

  • Stem Cell Therapies: The establishment of the National Stem Cell Transplant Program benefits the adult patients with outstanding outcomes.

  • Gene Chip Development: The alliance of the Qatar Genome Program (QGP) and local stakeholders catalyzed the gene chip development process. Consequently, a microarray chip content termed as Q-Chip was developed. It is based upon genetic and genomic data of Qatar nationals. Accurate genetic testing for a broad-spectrum of disorders as well as clinical diagnosis of cancer are some significant advantages of Q-Chip.

  • Precision Medicine: Qatar has introduced a contemporary establishment named “Qatar Precision Medicine Institute (QPMI).” It works closely with local institutional bodies and Healthcare Providers to develop illustrations of precision medicine as an example for patients with predisposition or who have high cancer risk.

  • Cancer Research: In 2013, the Qatar Cancer Research Partnership (QCRP) was established. The main objective of this system is to supervise the implementation of research programs in addition to academic components of cancer strategies [1].

21.2.4 Cancer Statistics in Qatar

We attained new, sex-specific cancer incidence data along with mortality rates from the International Agency for Research in Cancer (IARC) GLOBOCAN program. A total of 1482 new cancer cases were reported in 2020. Overall, breast cancer (14.7%) was the most commonly occurring cancer in the year 2020, next in order was colorectal (11.7%), followed by prostate (7%) (Fig. 21.2). Breast cancer was at the top among females with 218 cases, while colorectal cancer was highest in males with 112 cases (Table 21.1) [2].

Fig. 21.2
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Cancer incident cases in the State of Qatar (2020) [2]. Used with permission from International Agency of Research on Cancer (IARC)/GLOBOCAN

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Table 21.1 Sex-specified new cancer cases in the State of Qatar (2020) [2]
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21.3 Union of the Comoros

21.3.1 Introduction

Union of the Comoros, a group of islands, is an independent state which is located in the Indian Ocean, between Madagascar and the Southeast African mainland. Comoros has witnessed the departure of its educated and skilled workforce to France. Subsequently, a constant decline in Gross Domestic Product (GDP) was observed. The main sources of income in the Comoros are agriculture and farming. Most of its inhabitants live below the subsistence level. The beautiful beaches have always caught the attention of tourists. However, the authorities’ struggle to develop a tourism industry which is still in an exploration phase [3].

Each island has its own hospitals. However, the healthcare system has a dearth of medical workforce, state-of-the-art resources, and supplies [3].

21.3.2 Cancer Statistics in Comoros

GLOBOCAN (2020) reported new, sex-specific cancer incidence data in the Comoros. A total of 609 new cancer cases were reported in 2020. Cervix uteri cancer (27.4%) was the most commonly occurring cancer, next in order was prostate (10.7%), followed by breast (10%) cancer (Fig. 21.3). Cervix uteri cancer was at the top among females with 167 cases, while prostate cancer with 65 cases was at the top among males (Table 21.2) [2].

Fig. 21.3
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Cancer incident cases in Union of the Comoros (2020) [2]. Used with permission from International Agency of Research on Cancer (IARC)/GLOBOCAN

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Table 21.2 Sex-specified new cancer cases in Union of the Comoros (2020) [2]
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The Union of the Comoros is one of the countries that gravitates towards the lowest score on the Human Development Index (HDI). Also, it is included among those countries which have the highest cervical cancer rates. Low HDI countries fail to carry out important systematic affairs including, gender equality, female reproductive health, academic accomplishments, empowerment, and manpower contribution [4].

21.4 Republic of Djibouti

21.4.1 Introduction

The Republic of Djibouti is a small country located on the Northeast coast of the Horn of Africa. Categorically, the 4/5th population is urban, which makes it the top metropolitan country in sub-Saharan Africa. Djibouti has few insufficient natural resources. The restricted capacity of agriculture due to the harsh landscape and industrial activities have affected the socioeconomic situation of the country, resulting in unemployment, a regular shortfall in the budget, and foreign liabilities [5]. Additionally, Djibouti is highly affected by the recurrence of droughts [6]. However, in the recent past, Djibouti has reported development in its economy with 4.5% growth in 2011, 6.5% in 2016, and a 7% expansion in 2017 [7].

A recent study listed the availability of medical devices (including Computed Tomography [CT], Magnetic Resonance Imaging [MRI], Positron Emission Tomography [PET], gamma camera, mammography, radiotherapy equipment) in African countries. Djibouti falls under the category of those countries that have either limited equipment or lack of data [8]. Another study reported countries with demand for radiotherapy (RT) but have no accessibility to them. Djibouti is listed among these countries and had 307 radiotherapy patients, indicating the demand for RT services in 2013 [9].

21.4.2 Cancer Statistics in Djibouti

A total of 765 new cancer cases were reported by GLOBOCAN in 2020. Breast cancer has the highest percentage among new cases (24.7%), followed by cervix uteri and colorectal cancers with 8.2% and 7.6%, respectively (Fig. 21.4). Breast cancer was the leading cancer among females with 189 cases, and prostate cancer was the leading cancer in males with 37 cases (Table 21.3) [2].

Fig. 21.4
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Cancer incident cases in the Republic of Djibouti (2020) [2]. Used with permission from International Agency of Research on Cancer (IARC)/GLOBOCAN

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Table 21.3 Sex-specified new cancer cases in the Republic of Djibouti (2020) [2]
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21.5 Collective Data of Cancer Mortality

The 2020 cancer mortality rates of Qatar, Comoros, and Djibouti are illustrated for the year 2018 (Fig. 21.5) [2, 10,11,−12].

Fig. 21.5
figure 5

Cancer mortality data of Qatar, Comoros, and Djibouti (2018 & 2020) [2, 10,11,−12]. Used with permission from International Agency of Research on Cancer (IARC)/GLOBOCAN and WHO. (This adaptation is not published by IARC/GLOBOCAN and WHO. Hence, none of them are responsible for the content or accuracy of this adaptation)

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21.6 Oncology Care Developmental Systems in Qatar, Comoros, Djibouti

Qatar has one of the highest per capita incomes worldwide. It has been striving to articulate the best strategies that can reform the oncology care infrastructure of the state [1]. Whereas the cancer care data for the Comoros and Djibouti was limited and acquired through the cancer country profiles elucidated by World Health Organization (WHO) (Table 21.4) [10,11,−12].

Table 21.4 Overview of oncology care profile for Qatar, Comoros, Djibouti [10,11,−12]
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The data on human resources for Qatar, Comoros, and Djibouti is presented in Fig. 21.6. Few oncology care manpower fields were not available.

Fig. 21.6
figure 6

Oncology Manpower in Qatar, Comoros, and Djibouti [10,11,−12]. Used with permission from World Health Organization (WHO). (This adaptation is not published by WHO. Hence, WHO is not responsible for the content or accuracy of this adaptation)

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21.7 Cancer Care Challenges

Cancer control plans in countries where the health system is still evolving have been aggravated by a lack of skilled professionals, high treatment and diagnostic costs, and the emergence of complicated personalized systematic treatment plans. Moreover, there are many factors, for instance, culture and habits, that contribute to indigent cancer awareness and prevention among the community. The supreme level of public awareness and education in Arab countries is yet to be achieved since Arab women only seek medical check-up when their cancer has developed to locally advanced or metastatic stages. This leads to late presentation, substandard patient outcomes and imprecise epidemiological data. There are a few considerable barriers to improving cancer outcomes in the Arab communities, including hurdles generated by the dissociation of innovative cancer research from service delivery, the fact that public awareness concerning cancer is relatively lower than misconceptions about the disease that are quite high, low uptake of screening programs in the Arab community perhaps owing to health and social beliefs about the disease, family relationships, shame or embarrassment, discomfort, fatalism and social stigma [13]. A few more challenges for optimum cancer care services include reliable diagnostics (in addition to advanced pathology services and staging), fragmented treatment option (chiefly for radiotherapy administration along with complete scope of systematic treatment), establishment and upkeep of cancer data registries for their respective countries, and coordination of multi-disciplinary spheres to broaden outreach programs for the community [13].

There is a lack of cancer data from the Comoros and Djibouti. Moreover, cancer research is nominal in these countries. A patient-centered approach is required to provide excellent care for their patients. Health authorities should implement feasible strategic plans to expand cancer control and prevention measures in the community.

21.8 Conclusion

Qatar has one of the highest per capita incomes across the globe. It has invested in healthcare infrastructure and state-of-the-art technologies, which resulted in upgraded cancer care facilities across the country. The research and other oncology supporting fields are also at an advanced stage. Conversely, oncology care services in the Comoros and Djibouti are still underdeveloped. This chapter highlighted epidemiology and cancer services in the respective countries while indicating unavailable facilities through WHO data.

Conflict of Interest Authors have no conflict of interest to declare.