Saudi GU Working Group Preparatory Meeting

Saudi Gu Working Event

The inaugural Saudi Genitourinary (GU) Working Group preparatory meeting gathered a distinguished panel of healthcare experts from the fields of urology, uro-oncology, and medical oncology. Representing major healthcare institutions across Saudi Arabia, the panel aimed to collaboratively address the challenges related to the diagnosis, referral, and management of GU malignancies.

The meeting established a framework to promote educational initiatives, standardize referral pathways, enhance early diagnosis, and streamline multidisciplinary care.

It also recognized thenecessity for governmental collaboration to influence healthcare practices at a national level effectively. This report expands on all aspects of the discussions, outcomes, and proposed initiatives and provides a detailed roadmap for moving forward. The meeting was divided into two fruitful sessions that lasted for approximately two hours.

Meeting Objectives

Primary Objectives:

Establish a multidisciplinary working group dedicated to GU malignancies.
Promote collaboration between urologists, uro-oncologists, and medical oncologists.
Develop a unified, evidence-based approach to diagnosis, referral, and treatment.
Create educational platforms to disseminate up-to-date medical knowledge.
Initiate research efforts to generate local evidence and drive policy changes.

Secondary Objectives:

Identify systemic inefficiencies in the current referral and treatment pathways.
Propose actionable recommendations to streamline patient journeys.
Explore digital platforms for education and information dissemination.

NAME	INSTITUTION	COUNTRY
Ahmed Hashiesh	Moderator,Pfizer	KSA
Asharf Abosamra	Chairman,SAUDI URO-Oncology Group	KSA
Mohammed Shouki Bazarbashi	Medical Oncologist, King Faisal Specialist Hospital and Research Center, Riyadh	KSA
Faisal Azam	Consultant Medical Oncologist, King Fahd Specialist Hospital, Dammam	KSA
Bassam Basuliman	Medical Oncology Consultant	KSA
Mofarej Alhogbani	Urologist, King Fahd Medical Center	KSA
Esam Murshid	Oncology Department, Ministry of Defense Health Services	KSA
Sultan Saud Alkhateeb	Urologist, King Faisal Specialist Hospital	KSA
Faisal Albadaniah	Medical Oncologist, King Abdullah Medical City	KSA

1. Patient Journey Challenges

1.1 Diagnostic Delays
The group identified significant delays from the onset of symptoms (especially hematuria) to diagnosis and treatment initiation. Many patients experienced extensive delays after visiting multiple institutions and physicians before reaching specialized care.
1.2 Fragmented Referral Systems
Inconsistent pathways between private and public healthcare sectors further complicated timely access to specialized care. Institutions operate in silos without integrated referral frameworks.
1.3 Late-Stage Presentations
Due to delays in diagnosis and treatment, patients often present at advanced stages (muscleinvasive or metastatic) rather than at early, more treatable stages.

2. Root Causes Identified

2.1 Public Awareness Gaps
There is insufficient public knowledge about the seriousness of symptoms like hematuria. Many patients dismiss early signs, delaying care-seeking behavior.
2.2 Primary Care Gaps
Primary healthcare providers and general urologists sometimes fail to recognize the red flags of GU malignancies promptly, resulting in inappropriate treatments (e.g., repeated antibiotics for hematuria).
2.3 System Inefficiencies
Referral bottlenecks, inadequate documentation, missing diagnostic workups, and poorly defined responsibilities among different specialties further exacerbate delays.
2.4 Lack of Standardized Guidelines
Absence of clear national protocols for referral timelines, required investigations, and multidisciplinary team (MDT) engagement compounds variability.

Solutions and Recommendations

1. National Referral Pathways

1.1 Standardized Criteria
Develop and implement clear, disease-specific referral criteria for suspected GU cancers. For example:
• Hematuria with risk factors warrants immediate referral.
• Specific timelines from symptom recognition to diagnostic cystoscopy.
1.2 Referral Checklists
Create mandatory checklists that must accompany referrals, including:
• Imaging (CT scan)
• Cytology and histopathology reports
• PSA levels (for prostate evaluation)
• Comprehensive medical history and comorbidity evaluation
1.3 Timelines
Establish benchmarks for acceptable timeframes:
• From symptom onset to first specialist visit: <2 weeks
• From diagnosis to treatment initiation: <4 weeks

2. Establishment of Specialized Clinics

2.1 Hematuria Clinics
Following the model of breast cancer pathways, specialized hematuria clinics could provide same-day imaging, cystoscopy, and evaluation, significantly reducing diagnostic delays.
2.2 Center of Excellence Model
Develop regional centers of excellence with multidisciplinary teams capable of providing rapid, coordinated care to GU cancer patients.

3. Multidisciplinary Tumor Boards

3.1 Mandatory Case Discussions
All GU cancer cases should be presented at regional MDT tumor boards before major treatment decisions.
3.2 Cross-Sector Collaboration
Encourage private sector participation through MOUs and digital platforms.
3.3 Virtual Tumor Boards
Utilize telemedicine platforms to allow cross-institutional participation, especially from remote areas.

4. Insights from Bader Early Detection Program

Presented by Dr. Esam Murshid.
Ministry of Defense initiative covering 5.8 million people.
Early detection effective, but major delays exist in internal referrals.
35% of diagnosed patients fail to access definitive treatment promptly.
Insurance authorizations and internal bottlenecks identified as obstacles.
Emphasized that early detection must be coupled with efficient care pathways

5. Feasibility of National Change

An Advisor highlighted that real change requires MOH involvement.
Emphasized challenges in unifying practices across independent sectors.
Advocated for presenting data-driven recommendations to health authorities.

6. Public and Physician Education Campaigns

6.1 Patient Awareness

Create short, culturally adapted educational videos and infographics.
Promote messages via SMS, WhatsApp, LinkedIn, and public campaigns.
Focus on hematuria as a potential early sign of cancer.

6.2 Primary Care Education

Conduct CME activities targeting family physicians and general urologists.
Disseminate quick-reference guidelines and pathways
Integrate GU malignancy red flags into routine family medicine training

7. Digital Platforms

7.1 Website Development

Launch an HCP-only educational platform with:

Best practices for diagnosis and referral.
Downloadable checklists.
Updated clinical guidelines and consensus statements.

An Important Highlight:
Discussion on the Educational Website: Ownership, Moderation, and Dissemination

A major part of the discussion focused on creating an HCP-only educational website.
The following points were agreed upon:

Ownership: The website would be owned by the Saudi GU Working Group to maintain scientific neutrality and independence.
Moderation: All content (including referral checklists, educational modules, and best practice guidelines) would be created, reviewed, and approved solely by the Steering Committee.No external entity would control scientific content.
Support Role of Pfizer: Ahmed Hashiesh clarified that Pfizer would only assist in the logistical and technical setup of the platform. Pfizer would not be involved in content creation, governance, or approvals.
Content: The website would initially host referral checklists, quick educational guides, links to upcoming CME activities, and news about upcoming audits or collaborative studies.

Dissemination Strategy:

QR codes linking directly to the website would be distributed at primary healthcare centers, hospitals, and conferences.
CME events and webinars would introduce the website to broader audiences.
Institutional endorsements: Participating hospitals and societies would promote the platform through internal newsletters and networks.
Active promotion during advisory boards and GU-focused events.
Professional outreach through LinkedIn, targeting healthcare professionals with short educational posts designed to raise awareness about referral best practices and direct traffic to the website.
It was emphasized by several members that ease of access was critical, and the platform should not require complex registrations to encourage widespread use.

8. Research and Evidence Generation

8.1 Multicenter Audit

Perform an audit across different institutions to:

Document referral delays.
Quantify late-stage diagnoses.
Identify major bottlenecks.

8.2 Publications

Publish findings to highlight local challenges.
Advocate for change by presenting data to health authorities.

9. Engagement with Health Authorities

9.1 Policy Advocacy

Present white papers and evidence summaries to MOH and health clusters.
Propose pilot projects for streamlined referrals.

9.2 Insurance Engagement

Work with payers to ensure early investigations (e.g., CT scans) are reimbursed when red flags are present.

Challenges and Barriers

1. Governmental Engagement
Broad systemic changes (e.g., national pathways) require high-level governmental involvement, which is outside the immediate scope of a working group alone.
2. Healthcare Sector Fragmentation
Multiple independent healthcare providers complicate the implementation of uniform referral processes.
3. Data Sharing Restrictions
Concerns about confidentiality and competition may hinder cross-institutional collaboration.
4. Patient Behavior
Public health education must combat traditional health-seeking behaviors and mistrust in early investigations.
5. Resource Limitations
Smaller centers may lack infrastructure (e.g., cystoscopy capability) to comply with standardized pathways immediately.

Immediate Next Steps

1. White Paper Development

Draft an initial position paper by July 2025 addressing:

Patient journey challenges.
Recommended referral and diagnostic pathways.
Proposed models for education and collaboration.

2. Checklist Finalization

Develop disease-specific checklists and disseminate drafts for feedback from the working group.

3. Website Launch Preparation

Finalize platform design and content approval protocols.
Set criteria for HCP access only.
Prepare QR code promotional materials for clinics.

4. Research Planning

Design a protocol for a retrospective multicenter audit.
Identify lead investigators at each participating center.

5. Next Meetings

Schedule a follow-up meeting by 17th June 2025 to review draft white paper and checklist prototypes.
Plan the first educational webinar for primary care physicians.

Long-Term Vision

The Saudi GU Working Group aims to:

Become the national reference body for GU malignancy referral and treatment
guidelines.
Collaborate with the Saudi National Cancer Center and the Saudi Uro-Oncology Group.
Foster continuous education through live events, digital platforms, and academic research.
Ensure equity of access to early diagnosis and state-of-the-art treatment across the Kingdom.
Advocate for centralized GU oncology care under a national accreditation system.

Action Plan

Short-Term (0-3 months)

Finalize referral checklist drafts.
Complete draft of white paper.
Launch educational platform with initial resources.
Distribute QR codes to healthcare centers.

Medium-Term (4-9 months)

Complete initial multicenter audit.
Organize educational webinars.
Engage health authorities with data presentations.

Long-Term (9-18 months)

Pilot hematuria clinics in key cities.
Expand educational outreach nationally.
Formalizemultidisciplinary tumor boards.

Closing Reflections

Despite recognizing the numerous hurdles that exist, the Saudi GU Working Group demonstrated an exceptional commitment to improving patient outcomes. The collaborative spirit and practical mindset of the participants lay a solid foundation for progress.
The focus on tangible first steps, realistic goal-setting, and evidence-based advocacy provides a clear path to achieving meaningful improvements in GU cancer care in Saudi Arabia.By leveraging collective expertise and maintaining alignment with broader national health priorities, this working group has the potential to catalyze lasting change.

The success of this initiative will ultimately hinge on maintaining momentum, fostering partnerships, and remaining adaptable to evolving healthcare landscapes.