In 1996, the Executive Body recommended in its 45th meeting held in Riyadh 24-25/7/1417 (4-5/12/1996) that the member states should initiate establishing national programs for cancer control that cover prevention, early detection and treatment of cancer as well as strengthening their national health information systems, collecting data about cancer based on HMC resolutions: # 7 for 8th conference in Safar 1400 (January 1980), and # 12 for 14th conference in Rabi’I 1403 (January 1983).
Given the fact that many GCC countries have programs for cancer control, the Executive Board sought to revive the subject of cancer registration and called upon the countries to participate in a workshop held in Riyadh 9-11 Shawwal 1417H (16-18 February 1997) in coordination and cooperation with the National Training Center in the Ministry of Health, KSA, and King Faisal Specialist Hospital as well as the International Union Against Cancer (UICC) with the participation of the rest of the GCC states, some other related organizations, societies and unions, where it was agreed on a unified form involving the least required collected data to register cancer cases and mortalities in the GCC States.
The HMC in its 43rd conference (Muharram 1418H / May 1997, Geneva) emphasized the importance of preparing national programs for cancer prevention and control as well as treatment in each member state. It was also requested that a reference centre is to be allocated in each state that undertakes the responsibility of collecting, tabulating, analyzing the data reported from all hospitals and health facilities to be sent later on to the Gulf center. It was recommended that this system is to be effective starting from January Ist, 1998.
The Gulf committee for cancer control held a meeting in Bahrain (7-8 Jumada’I, 1418H / 9-10 Sept. 1997) where it was agreed upon allocating the registration centers in each member state and was unanimously agreed on the selection of the National Tumor Center at King Faisal Specialist Hospital in Riyadh as a Gulf Center for collection and analysis of data as well as preparing the annual periodic report for the member states in addition to provision of training in the field of cancer registration and consultations to the member states. These recommendations were presented to the Executive Body which recommended performing the comparative in- depth analysis for the collected data at the International Agency for Research on Cancer (IARC) in Leon, France.
In Muharram 1421H (May 2000), the HMC in its 49th conference requested the Gulf Committee to prepare a control program for cancer that can be applied on the national level of each member state. The program is to be prepared in collaboration with the International Union against Cancer and the Non-communicable Diseases Department in WHO, and it has to include a timetable and the budget expected for that program to be presented for the states for review before it’s put into action. Also, the HMC requested the member states to make cancer reporting mandatory in all health facilities (governmental and non-governmental).
In the 50th conference (Shawwal 1421H / January, 2001, Kuwait), the HMC approved the chairmanship of H.E. Dr. Mohammed A. Al-Jarallah (Health Minister of Kuwait) of the task force that will set the Gulf program for cancer control. The Gulf Cancer Control Committee, therefore, was called upon to convene in Riyadh 10-11 Shab’an 1422 (27-28 Oct. 2001) to review and refine the working paper and reports submitted by the member states for that purpose. Based on that, the objectives of the said committee were reformulated to include : cancer registration, cancer control, training on cancer registration activities, participation in the epidemiologic researches on cancer, cooperation with international organizations and national societies in this respect.
A workplan was set by the committee and a cancer control program was proposed which was based on 7 pillars:
1. Primary prevention.
2. Early detection.
3. Appropriate treatment.
4. Palliative care.
5. Research and studies.
6. Registration and evaluation.
7. Community participation.
The Executive Body in its 55th meeting in Riyadh issued recommendation # 6 which called upon the supervisor of the program to initiate establishing database for studies and researches about cancer in the member states. On the other hand, the HMC in its 52nd conference in Riyadh, Shawwal 1422 (January 2002) adopted this recommendation and referred the proposed control plan to the member states for further study and comments.
The Executive Body in its 56th meeting (Muharram 1423H / April 2002) recommended that the Gulf Center should coordinate with the related departments in WHO and IARC for review of statistical data, drawing conclusions and extracting the most prominent epidemiological indicators and trends. Also, it called upon the member states to participate in the training workshops organized by the IARC on how to transfer data to the modern computerized systems, and orientation about the recent trends in data coding.
In the light of this, we can summarize the efforts exerted by the Executive Board since the establishment of the Gulf Center for Cancer Registration Ramadan 1418 (January Ist, 1998) in the following :
I. In the field of cancer registration:
- Two workshops were held in Riyadh: the first was in 1997 in collaboration with UICC on how to reach data of cancer cases and how to code them. The second workshop was held in 1999 in Riyadh in collaboration with IARC and it was about the use of Can Reg. 3 system in entering and analysis of cancer data.
- Holding a specialized training course in Riyadh 3-7 Shab’an 1423 (9-13 October, 2002) in the field of cancer registration, improving performance and aiming at training on the new system for Cancer registration (Can Reg 4-5) and the updated international cancer coding ICD-10.
- Workshop : Concepts in Cancer Data Management
This has been held in Riyadh (4-5/11/1427 H/25-26/11/2006) in implementation to recommendation # 7 issued by the Executive Body in its 64th meeting for the purpose of improving the quality of performance, unifying used statistical tools and programmes. The targeted group was the coordinators and officers of the national cancer registration center in the member states.
b) Preparation of the Gulf Cancer Registration Manual:
The objective was to make clear the process of extracting data from files and its coding. The manual is illustrated and it has detailed information on how to fill in the registration form. The said center unified the method of coding cities and hospitals in all the Gulf States.
In coordination with IARC, a special version of Can Reg software was developed for the Gulf States, which was circulated to facilitate data entry of cancer cases as well as transfer and analysis.
d) Scientific Meetings:
Two symposia were held in collaboration with UICC about cancer registration, the first in Riyadh in 1997 and the second in Abu Dhabi in 1999.
The role of the Executive Board in this respect is to encourage conduction of epidemiologic research in the field of cancer, and provision of researchers with necessary information as well as contribution if possible.
- Preparation of the statistical report of cancer cases in the Gulf States for the years from 1999, to 2004 & Eight-year cancer indidence among nationals of the GCC States 1988-2005.
- Preparation of cancer control strategy in the Gulf States.
- Completion of the database dealing with cancer in the Gulf Cooperation Council States.
- Review of the Gulf Plan for cancer control with experts form WHO, NCD, and the IARC.
- The EB is seeking hard to make full use of the enthusiasm and energy of those people working in the Cancer Control Societies in the Gulf region in implementing the cancer control plan, by recruiting them to work in the Gulf Center.
In this context, the GCC member states are requested to :
1- Initiate data entry of cancer registration using Can Reg 4. the updated version) instead of the currently used version 3.
2- Transfer of the stored data from the old to the new version, and coordination with the Gulf Center for cancer registration in this respect.
3- Encourage joining the International Union for Cancer Registration for member states which have not yet joined the said union.
4- Update and complete the national plans for cancer control.
5- Support the web site of the Gulf Center for cancer registration on the internet, which has been updated lately.
The Executive body discussed all these issues in its 59th meeting held in Riyadh in November 2003 and its recommendations were presented to the 56th conference of the HMC (Doha, Dhu Al-Qa’dah 1424H / January 2004) which issued resolution # 3 which decided:
1- A timetable and chart indicating activities that are going to be undertaken in the Cancer Control Program within the Cancer Control Plan in the next five years.
2- The member states have to initiate, according to available facilities and resources, taking the necessary steps to put into effect and implement the cancer control plan.
3- Approval of amendments proposed by the Gulf Committee on the annual report of the Cancer Registration Center to match its counterpart reports issued by the IARC, Leon, France.
Positive Developments for Cancer Control Programme
The Executive Body affirmed the necessity to set an alternate Gulf plan for Cancer Control by the General Supervisor of the Cancer Registration and Control Center. The plan should be well defined, with clear objectives and with multiple sources of funding according to what has been indicated by the participants regarding the training programmes, printing and education plans (Recommendation # 5, for the 61st meeting of the Executive Body, Dhul Qada, 1425 H/January 2005).
The Health Ministers issued in their 59th conference resolution # 4 which states that: (Considering the King Faisal Specialist Hospital and Research Center, a reference center collaborating with the Executive Board, for the Health Ministers’ Council for the Cooperation Council States, in the field of Cancer Control).
Recommendation # 5 was issued by the Executive Body in its 63rd meeting held in Riyadh (Dhul Qada, 1426 H/ December 2005) which included the following:
1- Endorsement of the Gulf Plan for Cancer Control prepared by the specialized technical committee in conjunction with an expert from the WHO, International Agency for Cancer Research.
2- Approval of the prepared budget lines as proposed by the specialized technical committee to implement the Gulf Plan for Cancer Control with emphasis on serious commitment on the part of all participating and collaborating partners to implement the plan according to the set time frame.
3- Work towards promotion of the role of the civil societies in the Gulf programme for Cancer Control.
The Executive Body in its 64th meeting (Riyadh, Rabi I, 1427 H/April 2006) issued recommendation # 7 which affirmed the following:
- Preparing a guideline by the Gulf Center for Cancer Registration in collaboration with the specialized technical committee, for the purpose of setting a mechanism for issuing the annual report, to include a clear vision for the procedures according to a well defined timeline.
- Preparation for a training workshop on Improvement of the quality of statistical information and to train coordinators and officers of national registration centers in the Council States. This is to improve the quality of performance and to ensure quality and to unify the used statistical instruments and programmes.
- Improving methods of work and technical communication as well as exchange of information and follow up among national registration center in the Council states and the Gulf Center for Cancer Registration.
On the other hand, the Executive Board had intensified its efforts for development and sustaining this extremely important programme:
a) Consultation and Coordination with officials in the Saudi National Registration Center for Oncology & Research Center in King Faisal Specialist Hospital, where emphasis on continuous constructive collaboration was made, as well as methods of support of this Gulf Programme.
b) Coordination with the “Gulf Croup for Cancer Research” This is for the objective of issuing medical studies to unify methods and quality of diagnosis and treatment and to promote the scientific level of treating tumors in the Council States.
c) The Field visit for the Gulf Center Supervisor This was based on recommendation # 7 for the 64th meeting of the Executive Body, assigning the supervisor of the Gulf Center for cancer registration to conduct this field visit to assess the current situation defining the weaknesses and strengths, and methods of improving the quality of performance and exchange of experiences according to the available capacities in each country separately. The visit was made in mid 2006 and revealed a lot of leading points :
- The Council States have taken great steps in their national programmes for cancer registration, with some variations between the member states.
- The necessity to continue governmental support to the national centers and to train the national caders as well as holding an annual scientific meeting was emphasized.
- More specific details about each center separately in addition to some of the important technical directives are to be studied by the specialized technical committee.
d) Issuance of the Gulf Collaboration Report for Cancer (1998-2002) The first issue comes to crown the recommendation # 5 issued by the Executive Body (63) and according to the Executive plan.
Having discussed the Cancer Control Programme in the 65th meeting of the Executive Body, the latter issued recommendation # 6 which involved the following:
1- Thanking the Gulf Center for Cancer Registration in its new structure – for the constructive and fruitful cooperation to implement the directives of the Health Ministers’ Council and its Executive Body towards development of the program.
2- Assigning the Gulf committee for cancer control to study:
a) Follow up of the implementation of the endorsed Gulf plan for cancer control.
b) Coordination with the supervisors of the center about:
- Setting a vision for the research projects for the most common cancers in the Gulf and defining cases and means of prevention.
- Setting a scientific training programme for 5 years to build the professional capacities in the field of cancer registration.
3- Support of the request of the Gulf Association for Cancer Control to represent the Cooperation Council Countries in the voluntary side of the related international and regional authorities and organizations.
Outcome of the meeting of the Gulf Committee for Cancer Registration and Control (Riyadh, 22-23/8/1428 H/4-5/9/2007)
- Recommendations of this said meeting dealt with the mechanisms for issuing annual reports for the years 2004/2005.
- The committee updated all activities in the Gulf plan for cancer control (2007) and added items for the follow up table. Shortcomings were defined and outlines for overcoming them were proposed.
- A sub-plan was put to be implemented in 2008 through emphasis on 2 key items:
1- Awareness plan about risk factors leading to cancer.
2- Giving effect to elements of palliative care.
- Scientific activities included:
Three research projects were proposed according to the priorities and prevalence of cancer in the Council States, namely study of the quality of cancer registration data, an epidemiological study on increased cancer thyroid in women in the Gulf region and an epidemiological study about leukemia in adults.
- Training and Qualification Activities:
• Setting an integrated training program for beginners as well as advanced courses at the international and Gulf level which is considered a turning development point for the programmes.
• Arranging for holding a training course for qualifying the cancer registration officials (beginners) in cooperation with the Gulf Center for Cancer Registration and the Saudi National Cancer Registry in Riyadh. This is to overcome the shortage in the qualified and trained national technical caders.
Recommendation # 13 of the 67th Executive Body Meeting
In this meeting (Riyadh, 8-10/11/1428 H/ 18-20/11/2007 ) all developments and achievements were presented and was issued, which included the following:
I- Improving the national and Gulf Cancer Registration Programmes:
Urging all the Council States to finalize preparing the documented data for cancer cases for 2004/2005, as agreed upon in the endorsed amended table. The annual report is to be issued in the specified time without inclusion of the late countries.
II- Giving effect to the Gulf Plan for Cancer Control
1- Defining a responsible body in the ministries of health to undertake this mission, through supervision, application, follow up and coordination with related bodies as well as marketing the plan and extending cooperation with the civil society and national organizations.
2- The necessity to focus on giving effect to the awareness plan about risk factors which lead to cancer within the activities of the Gulf plan for information and health education to avoid duplication and to save effort and money.
3- Establishing a work team composed of the members of the technical committee to set an integrated reference guideline for cancer registration and control, within 4 months.
4- Coordination with related medical authorities to give effect to the palliative care with all its dimensions according to the Gulf Plan for cancer control during 2008 utilizing the specialized centers in the Kingdom of Saudi Arabia.
III- Giving effect to and developing scientific and training activities
1- Encouraging conduction of Gulf scientific research in the field of canter control based on the data and findings of the collective Gulf report (1998-2002) and according to the following priorities:
a) A study on quality of cancer registration data.
b) An epidemiological study on the increased thyroid cancer cases in women in the Gulf Region.
c) An epidemiological study on leukemia in adults.
3- Approval on principle on the research project (An epidemiologic study on increased thyroid cancer in the Cooperation Council States ) and referring it to the \team, timeline of the research and the executive plan to finish the research.
Presence of national plan for
Presence of a national
committee for cancer control
Presence and activation of
a national law for tobacco control
Ratification of the WHO
Framework for Tobacco control
Presence of an awareness plan about risk factors leading to cancer (tobacco, nutrition, physical activity) and providing educational materials to cancer patients
Health promotion strategy was released
2- Early detection of cancer
Programs for early detection of cancer (breast, uterine cervix, colon, prostate cancer)
According to a
recommendation of one cancer experts, the situation is not cost effective or useful in some Gulf countries. This is due to the low incidence rates
The cancer control program (national, local, assumptive, systematic)
3- Diagnosis and treatment
Presence of guidelines for policies
Presence of guidelines for diagnosis and treatment of most common cancers.
Availability of curative services, surgical treatments
Radio therapy (device/millions)
Setting standard indicators
4- Palliative care
Presence of guidelines for alleviation of pain
Availability of morphine, all forms, in specialized and public hospitals treating cancer
Presence of home care for cancer patients
Rehabilitation services for cancer patients
5-Survillance and Control
Presence of national registry for cancer
Surveillance of cancer risk factors
Presence of scientific research on cancer control
The Gulf committee for Cancer Registration and Control (Sanaa, 27-28/6/1429 H / 1-2/7/2008) which recommended the following:
Assigning the Saudi Center and the Gulf Center for Cancer Registration to prepare a draft reference manual for unifying concepts and scientific criteria of tumor registration in the Council States.
Giving effect to communication with the Gulf Union for Cancer Control and coordination in implementation of the endorsed strategies for cancer control in the Cooperation Council States to allow more participation of the community organizations in this field.
The Gulf Committee for Cancer Registration and Control (Riyadh, 18-19/4/1430 H / 14-15/4/2009) which resulted in a number of recommendations, the most prominent of which are:
Agreeing on the use of Cancer Registration System through electronic connectivity program, developed in the Research Center in King Faisal Specialist Hospital at Riyadh as a pilot experiment.
Extending cooperation ties with the Gulf Union for Cancer Control as an effective partner through signing a MoU with the Health Ministers’ Council for Cooperation Council States. And, according to the following priorities:
Health education and awareness – Support of building national capacities – promotion of scientific and training activities and support of scientific research.
Setting the Gulf Executive Plan for Cancer Control (2010 – 2020) which involved vision, mission, general objectives – targets, strategies, mechanisms of implementation and measurement indicators.
The 70th Executive Body Meeting (Riyadh, 7-8/5/1430 H, 2-3/5/2009), where it issued recommendation # 5 which approved:
The Gulf Executive Plan for Cancer Control (2010 – 2020)
The draft of the unified reference guidelines for tumor registration in the national and Gulf registration centers.
The use of the cancer registration system through the electronic connectivity program which was developed in the Research Center in the King Faisal Specialist Hospital.
The 71st Executive Body Meeting (Riyadh, 18-20/12/1430 H / 5-7/12/2009) where it issued recommendation # 5 which emphasized the following:
The use of the national ID # for cancer patients in replacement of the personal data (the name) in the Gulf registry of cancer patients, as of January 2006. This is to assure confidentially of personal data.
The necessity to provide the Gulf Center for Cancer Control with statistical data related to population (nationals) according to sex and age group for the most recent endorsed population census.
Restructuring of the Gulf Committee for Cancer Control to include executive health leasers, decision takers, experts and consultants in various fields of cancer prevention, treatment and research. This is to develop the Gulf program for cancer control, and follow up of implementation of the Gulf plan for cancer control (2010 – 2020)
Assigning the Gulf Committee for Cancer Control to put a comprehensive vision on the means of available and possible means for cooperation with the Gulf Union for community participation in implementation of the said plan, as well as promotion of joint Gulf scientific research.
Strengthening Cooperation with King Faisal Specialist Hospital and Research Center
This initiative was made by Prof. Tawfik Khoja – Director General of the Executive Board by a letter addressed to the Executive Council Supervisor of the hospital, alluding to the great and effecting role of the Gulf Center for Cancer Registration and expressed his thanks and gratitude for the endless and continuous support. This center came as embodiment of the resolution of # (1) issued by the 45th conference of the Health Ministers’ Council for the Cooperation Council States which called upon establishment of a registry for cancer cases in the Council States as of 1/1/1998.
The objective was to form the basis for a database on which the member states rely in their national programs for cancer prevention and control.
The center progressed through a very spectacular march to take this very eminent position at the Gulf and regional level as a specialized reference consultative center.
Based on recommendation # 5 issued by the Executive Body in its 71st meeting, a MoU was prepared in cooperation and coordination with specialized experts in the task force assigned for this purpose.
The Gulf committee for cancer control held a meeting in Riyadh (16-17 Dhul Qada, 1431 H / 24-25 October, 2010) which came up with the following recommendations:
1. Urging the Council States to complete their national executive plans to give effect to the endorsed Gulf plan for cancer control (2010 – 2020) and assigning a focal point for follow up and implementation in each country.
2. More emphasis on establishment of the national committee for cancer control, and the national center for cancer registration in the Yemen Republic (in effect of previous related recommendations of the executive body).
3. The committee members bless the exerted efforts in preparing the MoU and request raising it to the Executive Body for approval.
4. The committee praises the Gulf Center project for cancer control, which represents a very significant developmental step in the march of the Gulf program for cancer control.
5. Work towards issuance of the annual report of cancer for 2006 in such a way that the first draft of the report is to be submitted in the next Executive body meeting (Dec. 2010)
6. The COMMITTEE report (1998 – 2007) on the occasion of the tenth anniversary of the cancer Gulf registration, according to the mechanisms adopted by the Countries.
7. The necessity to give effect to the use of the national ID # instead of the name in the Cancer registration data to be effective within 3 months at maximum, together with the possibility of using the coding system proposed by the technical committees.
8. The necessity to work towards strengthening community participation and constructive cooperation with the Gulf Union for Cancer Control, and the counterpart national societies to implement the Gulf national plan derived from the Gulf endorsed plan (2010 – 2020) according to principles and criteria prepared in each Gulf State.
The 73rd Executive Body Meeting (Riyadh, 23-30/12/1431 H / 4-6/12/2010) which issued recommendation # 5 stating that:
1. The Executive Body congratulates Dr. Ali Jaffar, Health Affairs advisor and Executive Body member, Oman Sultanate for being awarded Kuwait Prize in the field of Cancer Control, awarded in the 57th Session of the EMRO (Cairo, 24-27/10/1431 H / 3-6/10/2010)
2. The Executive Body blesses the efforts exerted by Prof. Tawfik Khoja, Director General of the Executive Board in preparing MoU signed with King Faisal Specialist Hospital and Research Center, and raising it to the Health Ministers’ Council for the Cooperation Council States for approval and endorsement.
3. The Executive body praises the project for development of the Gulf for Cancer Control, and calls for raising it to the Health Ministers’ Council for the Cooperation Council States for approval and endorsement.
4. Holding a joint workshop with King Faisal Specialist Hospital in Riyadh for the purpose of transforming the objectives and mechanisms in the MoU into an integrated work program as well as an executive plan.
5. Established of the Consultative Body of the Gulf Center for Cancer Control, two members from each Gulf Country with long experience in this field of cancer management in addition to the national and international experiences stated in the project.
6. Urging the member states to complete setting the national executive plans to give effect to implementation of the Gulf executive plan for Cancer Control (2010 – 2020) and assigning a focal person for follow up and implementation in each country. The executive plans are to be updated according to recent international directions.
7. Assigning the Gulf Centers for Cancer Registration General Supervisor to coordinate with IARC experts concerning the mechanism of implementation of the new cancer registration system (Canreg – 5) to improve and develop work quality in the national cancer centers.
8. Work towards issuance of the cumulative report (1998 / 2007) on the 10th anniversary of starting Gulf registration of cancer.
The final draft is to be presented in the 74th Executive body meeting in April 2011.
Current Situation in the Council States:
a) Lack of programs of early detection of cancer breast (except Bahrain) and uterine cervix, colon and prostate cancers. This comes based upon a recommendation by one of the cancer experts that they are of no use due to the decreased prevalence rates of these cancers.
b) Most national plans for Cancer Control are in the phase of proposed projects, and required final endorsement for implementation.
1- Development of the Gulf Program for Cancer Registration:
a) Emphasis on continued constructive cooperation with the national cancer registry at the King Faisal Specialist Hospital Research Center. Development should include:
- A mechanism for issuing the annual and cumulative report every 5 years, work towards avoiding technical causes of delay of issuance of the report.
- More attention to quality of statistical data.
- Improving means of work and technical communications.
b) Improving the issuance process of the annual report according to the time table proposed by the specialized technical committee in this regard & in cooperation with the Gulf Center for Cancer Registration.
c) Performance Quality improvement of the national centers for cancer registration. The technical committee shall have field visits to provide technical consultations and for direct mutual communication to extend technical cooperation, training, evaluation and continuous improvement.
2- Giving effect to the Gulf Committee for Cancer Control:
a) Implementation of the technical and executive plan & putting financial alternatives for the estimated budget.
b) Defining a responsible entity in the MoU for supervision and follow up through:
- Giving effect to the activities and functions of the national committees for cancer control.
- Cooperation and coordination with governmental, academic, community agencies as well as private sector involved in the plan.
- Good marketing to include supportive elements especially community society organizations with various visions.
c) Commitment of all participating agencies
- Emphasis on the proposals made by the specialized technical committee in this respect.
- One of the Council States should adopt the Gulf plan for Cancer Control and to undertake follow up and giving effect to its activities.
d) Giving effect to the role of Gulf and national societies with the Gulf committee in the cancer control program.
The necessity to include these societies within the general framework and the executive plan for the Gulf Committee for Cancer Control.
3- Improving the scientific and training Activities:
This is to cope with the recent world trends through:
a) Focus on scientific research to control the most common cancer types.
b) An integrated Training (Qualifying) program for Cancer registrars (basic and advanced).
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