Addressing Cancer Treatment Shortages in Saudi Arabia: Results of a National Survey and Expert Panel Recommendations.

PURPOSE: Cancer treatment shortages are complex and a persistent problem worldwide. Patients with cancer are most vulnerable to drug shortages, which provides opportunities to examine the extent of the challenge(s) facing Saudi Arabia and to provide recommendations toward mitigating the impact of cancer treatment shortages on patient outcomes. MATERIALS AND METHODS: A qualitative methodologic approach was conducted in April 2019 using a validated questionnaire and structured panel discussion for data generation. RESULTS: Overall, 55 responses were received from practicing oncology health care professionals (26 pharmacists and 29 physicians). The annual average number of treated patients with cancer per institution was 640 (adults [n = 400] and pediatric [n = 240]). All respondents (100%) reported that cancer treatment shortages constitute a current problem in their center, with an average of 5 (range, 1-9) per month. The panelists recognized 2 fundamental points. First, the definition of cancer drug shortages should be standardized and recognized at the national level. Second, the current system must be improved to ensure proper and efficient use of the current resources. On that basis, the panelists developed 9 recommendations for action. CONCLUSION: Cancer drug shortage is a significant problem in all health centers in Saudi Arabia. This study presents challenges that should be addressed at the national level and essential consensus recommendations for a coordinated action developed by a panel of experts to tackle the current national problem of cancer treatment shortages. Implementing these recommendations will provide a blueprint for management of national drug shortages in general and cancer treatment shortages in particular.

Minimally invasive retroperitoneal adrenalectomy.

The minimally invasive MI approach has become the gold standard in removing the adrenal gland. Both transperitoneal and retroperitoneal techniques were reported safe and effective. The retroperitoneal approach has the advantage of direct access to the gland, easy access to retrocaval tumors, carries no cardiovascular or pulmonary risk of carbon dioxide insufflation to a high intra-abdominal pressure, and is not affected by previous abdominal surgery or radiation. We report a case of MI retroperitoneal adrenalectomy for right adrenal incidentaloma in a recently diagnosed breast cancer patient with multiple medical problems, and emphasize the advantage of this approach over the MI transperitoneal approach in the presence of patient's co-morbidity.

Saudi Oncology Society clinical management guidelines for testicular germ cell tumors.

In this report, guidelines for the evaluation, medical and surgical management of testicular germ cell tumors is presented. It is categorized according to the stage of the disease using the tumor node metastasis staging system, 7th edition. The recommendations are presented with supporting level of evidence.