Omar Shamieh

Focusing on the Middle East, this narrative review examines how conflict contributes to delays across the cancer care continuum, including prevention, early detection, diagnosis, treatment, follow-up, survivorship, and palliative care. Mechanisms include the destruction of health facilities, workforce displacement, interrupted supply chains, constrained health budgets, and the diversion of services toward emergency response. These challenges reduce investment in prevention and restrict timely access to therapy, leading to poorer clinical outcomes and increased mortality. Sociocultural barriers, including stigma, misinformation, trauma, and limited public awareness, further delay patient presentation and undermine treatment adherence and continuity of care. This narrative review focuses on peer-reviewed studies and reports published between 2021 and 2026 (with older seminal studies for historical context) to clarify how conflict disrupts cancer care, analyze economic burdens and inequities, and map the relationships between health system fragility and sociocultural barriers. Drawing on this analysis, the review proposes a phased operational framework that tailors strategies—including mobile oncology, tele-oncology, decentralized diagnostics, cross-border referral, and supply chain safeguards—to the security and functional levels of each setting, as well as to governance and financing mechanisms.

Background: Jordan's health system has evolved amid rapid urbanization and the strain of hosting one of the world's largest refugee populations per capita. This study comprehensively evaluates national disease burden trends in Jordan from 1990 to 2023 to inform health priorities. Methods: Using the Global Burden of Disease (GBD) 2023 framework, we analyzed age‐standardized rates of disability‐adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) across 370 diseases and 88 risk factors. Data were derived from national censuses, health surveys, disease registries, and hospital records, and harmonized using standardized GBD modeling and estimation procedures. Analyses were stratified by age, sex, and cause. Results: Between 1990 and 2023, age‐standardized DALYs declined by 33.88% (95% UI: −37.38 to −30.59), with greater reductions in males (−38.83%; −42.22 to −35.60) than females (−27.22%; −31.33 to −23.58). YLLs decreased by 49.38% (−50.93 to −47.68), while YLDs remained comparatively stable (2.49%; −2.37 to 7.47). Using mutually exclusive GBD Level 3 causes, ischemic heart disease and diabetes mellitus were the two leading causes of DALYs in 2023. Diabetes mellitus rose from 7th place in 1990 to 2nd place in 2023, while neonatal disorders declined from 1st to 7th place. Metabolic risks remained important contributors to the overall disease burden. Jordan's age‐standardized diabetes DALY rate in 2023 was approximately 1.56 times the global rate. Conclusion: Jordan's health profile has shifted toward a greater burden from noncommunicable diseases, while age‐standardized health loss and premature mortality have declined substantially. In contrast, nonfatal disability changed comparatively little. These findings provide an evidence base for primary prevention of NCDs and for long‐term strategies addressing the country's evolving health challenges.

Purpose This study defined thresholds for clinical importance (TCIs) for the European Organisation for Research and Treatment of Cancer Communication Questionnaire (EORTC QLQ-COMU26). TCIs support the clinical evaluation of individual patients’ communication with professionals. Methods In this cross-sectional study, an international sample of cancer patients with mixed diagnoses and treatments completed the EORTC QLQ-COMU26, which comprises six scales and four individual items. Item 26, which evaluates patients’ satisfaction with communication with professionals, served as the anchor for detecting a negative event (unsatisfactory communication). Diagnostic accuracy for each domain was determined using ROC analysis, and the sensitivity of the TCIs was evaluated. Sensitivity analyses using multivariate binary logistic regression explored potential variability in TCIs across patient groups. Results A total of 988 patients from 13 countries participated (mean age, 60.7; 50.0% female). TCIs ranged from 80.3 to 92.5 on the 0–100 metric of the QLQ-COMU26 scales. All TCIs demonstrated sensitivity of at least 0.75, and ROC AUC values ranged from 0.80 to 0.90. Separate TCIs were identified for communication with nurses and doctors, with thresholds > 4 points higher for nurses in five QLQ-COMU26 domains. No evidence supported separate thresholds by age, gender, or treatment intention. Conclusion This study established TCIs with high diagnostic accuracy for the EORTC QLQ-COMU26, supporting its use in clinical practice and research. The findings suggest that the questionnaire can identify patients who report low communication for specific domains and help improve communication in clinical settings.

Background: Prostate cancer is associated with a substantial psychosocial burden, yet evidence regarding unmet supportive care needs in Middle Eastern contexts remains limited. This study aimed to determine the prevalence and predictors of unmet supportive care needs among Jordanian men with prostate cancer and to examine the mediating roles of coping strategies and perceived social support in relation to quality of life. Methods: A cross-sectional study was conducted between August 2024 and March 2025 among 300 Arabic-speaking men attending two tertiary hospitals in Amman, Jordan. Participants completed validated Arabic versions of the Supportive Care Needs Survey–Short Form (SCNS-SF34), WHOQOL-BREF, Brief COPE Inventory, and the Multidimensional Scale of Perceived Social Support (MSPSS). Data were analyzed using descriptive statistics, multiple linear regression, and structural equation modeling. Results: Psychological needs emerged as the most prevalent unmet domain, followed by health system and information needs. Higher levels of unmet needs were significantly associated with older age, lower educational attainment, unemployment, and advanced disease stage (P < 0.001). Emotion-focused coping strategies were reported more frequently than problem-focused approaches. Overall perceived social support ranged from moderate to high, with family support being the dominant source. Both coping strategies and perceived social support partially mediated the relationship between unmet supportive care needs and quality of life (P < 0.001). Conclusion: Jordanian men with prostate cancer experience considerable unmet psychological and informational needs. Targeted, culturally responsive psychosocial interventions that strengthen adaptive coping and social support networks are essential to improve quality of life in this population.

In low- and middle-income countries (LMIC), Do-Not-Resuscitate (DNR) discussions are often delayed or omitted, adversely affecting the quality of end-of-li

Introduction: Evidence from Middle Eastern cancer centers on the impact of palliative care on end-of-life practices remains limited. This study evaluated healthcare utilization, diagnostic costs, and timing of palliative care referral requests at a tertiary cancer center in Jordan. Materials and methods: We conducted a retrospective cohort study including all 299 adult cancer patients who died between February 2017 and May 2018. Patients were categorized based on the clinical service responsible at death (oncology vs. palliative care). Demographic and clinical characteristics, reasons for final hospitalization, and costs of laboratory and radiologic exams performed in the last seven days of life were extracted. Descriptive and univariate analyses were performed. Results: Of 299 patients, 151 (50.5%) were managed by palliative care at death. The mean (SD) age was 57.1 ± 14.3 years. The most common reasons for final admission were decreased level of consciousness 60 (20.1%) and pain crisis 57 (19.1%). Among the 148 oncology patients, 43 (29.1%) had documented palliative care referral requests but remained under oncology care at the time death. In the last seven days of life, 1,623 diagnostic exams were performed at a total cost of 186,572 USD. Oncology-managed patients had higher diagnostic intensity and costs compared to palliative patients (mean cost 856.58 vs. 397.38 USD; mean exams 6.6 vs. 4.2; both p < 0.001). Exams were performed closer to death in oncology patients (mean 0.39 vs. 2.92 days; p < 0.001). Referral requests were associated with longer referral-to-death intervals (median 14 vs. 1 day; p < 0.001). Discussion: Palliative care involvement was associated with lower diagnostic intensity and costs at end of life. However, referral requests were often late or not translated into active palliative management. Earlier and more consistent integration of palliative care may improve resource utilization and align care with patient-centered goals.

Introduction: Cultural beliefs significantly impact cancer perceptions, treatment choices, and care experiences. In Jordan, diverse patient background requires cultural competence and bias awareness among providers. This study aims to explore the cultural beliefs and practices of patients and their families in the experience of cancer care, and how these practices influence such care in Jordan. Materials and methods: This is a multi-center qualitative study used semi-structured face-to-face interviews with oncology healthcare providers, caregivers, and patients from three tertiary Jordanian hospitals providing cancer care. Purposive sampling was employed, and the interviews were analyzed using thematic analysis and NVivo 12 software. Results: We conducted 108 face-to-face interviews with 35 patients, 37 caregivers, and 36 providers. Notably, 22% of patients and caregivers were non-Jordanian. Thematic analysis identified five major themes shared across both Jordanian and non-Jordanian participants: (1) Tradition and Rituals: Preferences varied around food, visitations and modifications to usual religious practices, (2) Cancer Conceptualization: While many viewed cancer as a divine test, others attributed it to genetics, poor nutrition, stress, or environmental factors such as pollution, (3) Advance Directives and information sharing: Participants preferred timely discussions on directives with preferences ranging from proactive to gradual disclosure. Shared decision-making was emphasized. Typically involving physicians, family members, and key figures, especially the patient spouse or eldest male relative. Some caregivers and providers reported withholding details from patients and children upon family’s request, (4) Psychosocial and practical concerns: Participants expressed worries about treatment side effects, disease progression, financial burden, and the future of patient’ children, and (5) Healthcare Provider’s Characteristics: Patients preferred respect, and clinical expertise over providers’ gender, nationality, or religion. However they favored same-gender nurses for daily care and those who could communicate in Arabic. Discussion: The study demonstrates how culturally embedded beliefs, family dynamics, and faith-based interpretations uniquely shape cancer care interactions in Jordan. Addressing these context-specific cultural factors is essential for strengthening culturally responsive communication and patient-centered oncology services in the region.