Oncology Nursing in Lebanon

Since the end of the 15-year civil war in 1991, Lebanon has tried diligently to rebuild its infrastructure. Over the same period, Lebanon’s life expectancy has risen to 74-77 years. The country is experiencing an epidemiological shift, as prevalent diseases in high-income countries, such as diabetes, heart disease, cancer, and high blood pressure, have markedly increased, while diseases of low-income countries, such as infectious and communicable diseases, are declining but have not yet disappeared.¹

In the 21st century, expectations of life and death are distinct from those a century ago.² As the world population increased, life expectancy in both developed and developing countries has also increased. In Lebanon, the numbers of people aged above 65 years and older parallel those of the world. In 2015, Lebanon had the highest percentage of people aged 65 years and older (7.3%) in the Arab region, and this number is expected to reach 12% by the year 2030.³ Both the absolute and the relative number of older adults have increased at an unprecedented rate.

With longevity comes chronic, costly, and serious illnesses, including many types of cancer, with which the Lebanese healthcare system is ill-prepared to manage. Aside from age-related degenerative disorders, aging is a key risk factor for many types of cancer. All-cause cancer incidence peaks at around age 70 years.⁴ According to the National Cancer Registry of the Ministry of Health and the World Health Organization (WHO), the number of new cases of cancer in Lebanon has progressively increased over the past decade. In 2004, almost 7,200 new cases of cancer were reported in Lebanon, compared to over 9,400 in the most recent report.⁵This worrisome trend is not entirely due to aging, as expanded screening efforts and improved registration methods have likely contributed significantly. It is estimated that by 2030, the number of new cancer cases in Lebanon will approach 12,000.

Unfortunately, this steady increase in cancer cases and in aging is not accompanied by a proper distribution of specialized nurses across regions or by an increase in the number or expertise of the oncology nursing workforce to meet the population’s changing needs. The Lebanese health care system has been facing challenges and ambiguities,⁶ especially for the past two years, due to financial and political instability in the country; these factors have put substantial stress on both health care professionals and organizations. A main concern in Lebanon is the lack of a national health policy on human resources and the lack of a long-term strategy regulating the recruitment and distribution of health care professionals. An alarming “brain drain" has been discerned over the years, particularly for the nursing profession, with the exodus of nurses to the Gulf area, Europe and the Americas for better opportunities and pay.⁷ The main challenges facing the healthcare workforce in Lebanon include imbalanced professional and geographic distribution of providers/institutions, lack of relicensing of health professionals or accreditation of curricula, and limited continuing education programs and career development.⁸ The nursing workforce in Lebanon needs more specialized nurses, especially in oncology, to meet the increasing health needs of the population. In a study by Doumit, Lockhart, Nassif and Azoury,⁹ Lebanese nurses working in oncology expressed distress and emphasized the need for proper educational preparation in oncology in order to better meet their patients’ and professional needs. Resiliency programs that inform nurses about compassion fatigue, manage work stress and improve decision making, communication and satisfaction are highly needed.

Nursing in Lebanon enjoys a good system of higher nursing education. However, the profession struggles to identify its proper place and role within the Lebanese healthcare system. More efforts are needed at education and practice levels to retain Lebanese nurses through proper career ladders and better preparation in specialization such as cancer care.

Myrna A. A. Doumit, PhD, MPH, RN, FAAN is an associate professor at the Alice Ramez Chagoury School of Nursing Lebanese American University Byblos, Lebanon.

References

• WHO Noncommunicable diseases country profiles. (2018). Geneva: World Health Organization; 2018. License: CC BY-NC-SA 3.0 IGO accessed January 8, 2020
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• Mehio, A. S., Rizk, A., & Kronfol, N. M. (2015). Aging in Lebanon: perils and prospects. Le Journal Medical Libanais. The Lebanese Medical Journal, 63(1), 2-7.
• Sibai, A., & Kronfol, N. Country profile: Older population in Lebanon: Facts and prospects, Center for Studies on Aging A publications, 2011 http://www.csa.org.lb/cms/assets/archives/2011/13%20country%20profile%20elderly%20population%20in%20lebanon%20facts%20and%20prospects%20english.pdf Accessed January 8, 2020
• Ministry of Public Health website: www.moph.gov.lb. National Cancer Registry 2016; Accessed January 8, 2020
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• Doumit, M. A., Lockhart, J. S., Nassif, S., & Azoury, N. (2016). Understanding the personal meaning of work for oncology nurses in Lebanon: A qualitative hermeneutic phenomenological study. Journal of Theory Construction & Testing, 20(2), 53-61.