Awareness, understanding, attitude and barriers toward prescribing modern cancer immunotherapies in the Arabian Gulf countries

Al-Shamsi HO, Tashkandi E, Bukhari N, Al Farsi A, Alnajjar A, Alhuraiji A, Foheidi M, Sagheir A, Bin Thani K, Al Bahrani B, Alrawi S.
Gulf J Oncolog. 2018 May;1(27):45-51.


Introduction: The use of modern immunotherapy has been evolving over the past few years, and various new agents have been developed for new indications at multiple primary sites in oncology. It is important for physicians who are involved in cancer care to be aware and updated about new therapeutic agents and their indications, potential benefits, and side effects.

Patients and Methods: From October to November 2017, we conducted a survey on the awareness, understanding, attitude, and barriers associated with prescribing modern cancer immunotherapies among physicians in the Arabian Gulf countries. The study included practicing physicians who delivered chemotherapy; trainees were not eligible. A total of 460 physicians were contacted and invited to complete an online survey, of which approximately 74.8% did not respond, and 4 (3.4%) were excluded because they had not recently treated patients with cancer. 112 (24.3%) physicians completed the survey (completion rate = 25.2%). An online electronic survey questionnaire was developed via Planet Surveys. The survey was designed with multidisciplinary inputs of the study investigators practicing in the Arabian Gulf countries, piloted, and subsequently revised on the basis of feedback from 10 additional oncologists. The final survey included 23 questions and took 8–10 minutes for completion.

Results: All respondents were aware of modern immunotherapies, but 62.5% reported having limited
experience in implementing them, whereas 31.3% reported good experience. The overall physicians’ attitudes toward modern immunotherapy were favorable, with a mean score of 7.4 (scale of 1–10, with 10 being extremely favorable). Efficacy, clear indications, and good safety profile were perceived as key potential benefits. Cost, lack of experience, and lack of access to specific testing were the major barriers.

Discussion and Conclusion: There was a high level of awareness and an overall positive attitude toward
modern cancer immunotherapy among oncologists in the Arabian Gulf countries, but there was a limited experience in prescribing cancer immunotherapeutic agents. Efficacy, clear indications, and good safety profile were perceived as key potential benefits, whereas cost, lack of experience, and lack of access to specific testing prior to prescription were the major barriers. Patients were likely to be receptive to modern immunotherapy as a therapeutic option for cancer treatment. Long-term efficacy data, financial support programs, and educational activities for prescribers may increase the access to modern immunotherapy.

Keywords: Immunotherapy, Personalized medicine, Arab World, Middle east, Mutation

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