By Deborah Mukherji, MBBS, Sana Al-Sukhun, MD, MSc, Shaheenah Dawood, MD, Iman Abou Dalle, MD, and Sally Temraz, MD
The COVID-19 pandemic has turned everyone’s lives upside down. Health care workers are struggling to cope with a devastating new disease with far-reaching health and socioeconomic consequences. We oncologists, who would not usually think twice about supressing the immune system with chemotherapy, are increasingly nervous about the increased risks of this novel infection in our patient population. Workflows have changed beyond recognition as we try to protect vulnerable patients who trust us to balance the risks and benefits of anticancer treatment. Elective surgery has been postponed, videoconferencing has replaced face-to-face meetings, clinical research has been disrupted, and previously busy clinics have been reduced to the most urgent of visits. Anxiety levels are high; patients are dealing with both a cancer diagnosis and the threat of COVID-19 infection, clinical teams are fragmented and operating under the pressure of uncertainty.
As we move through this crisis and adapt as well as we can, a natural reaction is to deal with this new threat is by acquiring as much knowledge as possible. A case series of 18 patients with a diagnosis of cancer and COVID-19 from China received 174 citations in the 2 months following publication.1,2 Local, national, and international cancer societies are all providing rapid opinion-based guidelines,3 grants are being made available for COVID-19–focused research, and manuscripts are being rushed to publication.
Another consequence has been the deluge of invitations to attend COVID-19–related webinars from a variety of sources. These range from national and international societies to pharmaceutical companies attempting to maintain contact with prescribing physicians. While webinars can be a useful way to rapidly disseminate information, the sheer volume of these unsolicited invitations has been unexpected.
Another unexpected phenomenon has been the disregard for gender equity on these “expert” presenting panels, despite good representation of female oncologists on committees reviewing data to give recommendations for practicing oncologists in the face of the pandemic. The reprise of the all-male panel has been particularly apparent where we are based in the Middle East; however, we have been invited to several international all-male webinars. The last 10 webinar invitations received involved 39 men as speakers and moderators, and only one woman. This phenomenon has not been restricted to oncology; the organisers of an international webinar on “Mother and Newborn - Essentials for COVID-19” featuring an all-male panel were forced to add two female experts after strongly voiced criticism on social media.
For some time, there has been increased awareness in the academic community that all-male panels, or “manels,” are no longer acceptable.4 For some reason, this has been forgotten in the realm of online meetings. What could be the reason for this? In a time of crisis, is the voice of the male expert somehow more reassuring?5
An important aspect may be that women with children at home are dealing with increased family responsibilities and may have limited time for additional meetings.6 With these added pressures, there is even more reason for scientific educational meetings to be deliberately gender-inclusive and sensitive to the time commitments of all participants.
Clearly, there is more work to be done to improve gender equity due to the multiple barriers to female academic leadership. The reaction to this pandemic has outlined that panels of male experts remain the global default. We have exposed the fact that while many agree that diversity matters, without conscious effort the issue is neglected.
The Middle East and North Africa (MENA) region is recognized as having some of the lowest rates of women’s economic participation in the world. Female doctors are underrepresented in academic and leadership positions in oncology and other medical specialties. In 2018, we surveyed female attendees of the Lebanese Society of Medical Oncology (LSMO) and Arab Medical Association Against Cancer annual meeting using a questionnaire assessing socio-demographic characteristics, involvement in leadership and academic positions, and the impact of career on family life. Among the small sample of female oncologists surveyed, results were interestingly comparable to data from the rest of the world.7 Following the survey, we noted a welcome increase in discussions around gender equality issues. We were delighted to observe four times the number of female moderators and twice the number of female speakers invited to the 2019 LSMO meeting. This improvement was consistent with a conscious effort driven by voicing inequality concerns, rather than any change in the qualifications of the women involved.
As the medical and scientific communities have come together to deal as best as we can with COVID-19, continuing to raise awareness of the importance of diversity and inclusion remains as relevant as ever.
Authors’ note: All authors contributed to the manuscript and approved the final draft. No source of funding or conflicts of interest are declared.
Dr. Mukherji is a physician and associate professor of clinical medicine in the Division of Hematology/Oncology at the American University of Beirut Medical Center. Follow her on Twitter @dmukherji.
Dr. Al-Sukhun is the director of the Al Hyatt Oncology Practice. She is chair-elect of the ASCO International Affairs Committee and past president of the Jordanian Oncology Society. Follow her on Twitter @SanaAlSukhun.
Dr. Dawood is a physician at Mediclinic City Hospital in Dubai. Follow her on Twitter @Shaheenah1.
Dr. Abou Dalle is a physician in the Division of Hematology/Oncology at the American University of Beirut Medical Center. Follow her on Twitter @ImanAboudalle.
Dr. Temraz is a physician in the Division of Hematology/Oncology at the American University of Beirut Medical Center.
- Liang W, Guan W, Chen R, et al. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol. 2020;21:335-7.
- Desai A, Sachdeva S, Parekh T, et al. COVID-19 and Cancer: Lessons From a Pooled Meta-Analysis. JCO Glob Oncol. 2020;6:557-9.
- Burki TK. Cancer guidelines during the COVID-19 pandemic. Lancet Oncol. 2020;21:629‐30.
- The Editors Of The Lancet Group. The Lancet Group's commitments to gender equity and diversity. Lancet. 2019;394:452-3.
- Wenham C, Smith J, Morgan R. COVID-19: the gendered impacts of the outbreak. Lancet. 2020;395:846-8.
- Minello A. The pandemic and the female academic. Nature. Epub Apr 17 2020.
- Salem R, Haibe Y, Dagher C, et al. Female oncologists in the Middle East and North Africa: progress towards gender equality. ESMO Open. 2019;4:e000487.