Cancer poses an important global public health challenge and ranks as the second leading cause of death worldwide, following heart diseases. The American Association of Cancer Research states that the primary objective of the study of cancer is the development of safe and effective approaches for the prevention, detection, diagnosis, treatment and cure of this disease (1). Advancing the understanding of cancer, including its treatment options, preventive measures and psychological impact, is crucial for making substantial progress in the reduction of its profound human and economic toll on the well-being of patients. Enormous sums of money have been spent on cancer research worldwide (2). However, due to extensive exposure to numerous environmental chemicals in everyday life and the complex nature of chemical mixtures (3), it is challenging for long-term safety evaluations to provide perpetual true results concerning cancer diagnosis and treatment as well as accurate updates. An ultimate cure for cancer remains the top aim of numerous researchers (4). Despite the marked increase in cancer research and the substantial growth in the number of cancer survivors over the past three decades, it is undeniable that the global occurrence of this disease continues to rise (5). Regarding cancer survival, it has been reported that during the last decade half of the individuals diagnosed with cancer in England survived their disease for ≥10 years (6). While there have been numerous advancements in the pharmacological treatments of tumors, and new highly sensitive techniques for the early diagnosis of pathologies, including imaging, laboratory tests, tumor biopsy, endoscopic examination, surgery, genetic testing and microfluidic systems have been developed (7,8), a definite cure for cancer remains elusive. Nevertheless, researchers persist in their efforts to develop new and more effective treatments and preventive measures for cancer. For example, long-term epidemiological studies have identified specific risk factors, such as the maintenance of a healthy weight, avoidance of tobacco, limitation of alcohol intake and protection of the skin that, if reduced, can prevent the development of certain types of cancers (9,10). Moreover, cancer risk prediction models based on these epidemiologic data have identified the risk of an individual carrying a genetic mutation for a specific cancer, such as BRCA 1 and/or BRCA 2 (11). Additionally, several innovative treatments, including hormonal therapy, monoclonal antibodies and chimeric antigen receptor T-cell therapy (12), are already being used alongside more traditional cancer therapies. Research efforts are now particularly focused on the role of gene editing and nanoparticles in combating cancer cells (13). Furthermore, a recent breakthrough in our understanding of the regulatory functions of small RNAs, originally discovered in plants, is providing new insights into the biology of cancer (14). Despite the clear rational and contemporary interest in cancer research, its assessment comes with challenges. Firstly, despite the recent surge in interest, there remains a lack of knowledge regarding the most effective methods for conducting research assessments (15). Secondly, in 2020, updates on the diagnosis and treatment of cancer were negatively impacted by the coronavirus disease (COVID)-19 pandemic. Restrictive measures and the closure of healthcare settings during the pandemic led to limited access to care, resulting in delays to cancer diagnosis, treatment and research updates regarding cancer incidence and etiologies (16). In Lebanon, particularly at the Lebanese American University (LAU), several scientific studies were conducted to explore new cancer therapies and preventive measures (17–20). However, according to a 2021 report from the Global Cancer Observatory of the National Cancer Registry, there were 11,589 new cancer cases and 6,438 cancer-related deaths in Lebanon in 2020 (21). One notable finding is the absence of data on the survival rate of cancer cases in the official Lebanese registry maintained by the Lebanese Ministry of Public Health (22).

Hence, the objectives of the present review are to examine cancer research methodologies documented in LAU libraries, with a particular focus on publications following the outbreak of COVID-19, assess these methodologies, consolidate their key findings and provide recommendations for future assessments. The present study encompasses various aspects of cancer research, including fundamental laboratory investigations and human studies, as well as basic scientific and applied research. It encompasses research pertaining to pediatric or adult cancer, as well as studies spanning the nursing, medical and public health aspects of cancer research. Consequently, the study seeks to achieve the following: i) Identify existing literature reviews that document approaches to the assessment of research impact and summarize these approaches; ii) summarize the findings of each study based on different cancer types; and iii) make recommendations to steer future cancer research towards addressing the specific requirements of the Lebanese population.

The present study focused on the analysis of publications from the LAU (Beirut, Lebanon) over the past 5 years, specifically from 2017 to 2022. These publications were selected as a representative sample of a Middle Eastern academic and medical research center. During this time period, the School of Pharmacy and the School of Medicine at LAU actively participated in cancer research, conducted studies and stayed up-to-date with the latest advancements. The dataset used for analysis was obtained from SciVal (https://librairies.lau.edu.lb/research/databases/?index=S#id_libdbform), a research performance assessment tool that facilitates the analysis of data from Scopus and Web of Science (WOS). While there were variations in coverage between these two indices, the present study considered articles that appeared in both to provide a broader perspective on the correlation between citation count and author number. The study of published cancer research at LAU is based on the collaborative efforts between academic researchers and medical physicians. The search was initiated under ‘all subject areas’ and then proceeded using specific themes such as ‘medicine’ and ‘cancer research’. Published works were also extracted with specific keywords such as ‘neo*’, ‘tumor’, ‘cancer’, ‘oncol*’, ‘leukem*’, ‘lymph*’, ‘chemo*’ and ‘radio*’ as individual topics. The search in the category ‘institutions and groups’ was limited to ‘The Lebanese American University’; Lebanon was the country of choice in the category ‘countries/regions’ and the date limits were ‘2017–2022’. The data obtained from SciVal included i) article title, ii) author names, iii) author count, iv) citation count, v) field-weighted citation impact, and vi) CiteScore (CS). Bibliometric analysis was performed to compare the published works in the present study. In order to achieve this objective, the CS was used as the primary method for counting citations (23,24). The present review only included published articles and focused exclusively on peer-reviewed journals, even though the selection of journals may vary depending on the citation-based metric system being considered, resulting in different quartiles. No restrictions were made regarding author names and collaborations. Additionally, single- and hyper-authored publications, abstracts only, studies written in a language other than English, corrections to previous studies, errata, conference proceedings and book series were excluded.

Nearly all the published research from the specified years were included in the present study. To ensure accuracy and relevance, two independent reviewers conducted a thorough screening of all records based on the topic search. The screening process involved reviewing study titles for potential relevance to cancer research and examining the full-text articles for specific references to cancer.

Between 2017 and 2022, a total of 2,137 research works by LAU were published in journals indexed in Scopus and WOS, covering various research fields. Out of these, 252 studies specifically focused on cancer research. Following the PRISMA guidelines, a thorough screening process was conducted based on the titles and abstracts of the publications as depicted in Fig. 1. After removing duplicates, corrections and errata, 124 papers remained for full-text review. Ultimately, 72 studies were deemed eligible and met the inclusion criteria. The number of publications gradually increased from 2017 until 2021, reaching its peak in 2020, when 26.3% of the studies were published and remained constant in 2021. However, the number of papers published dropped in 2022 (Fig. 2), comprising only 8.3% of the studies in this time period. Among the 72 publications, 25 focused on in vitro or animal studies, while 47 were patient-associated studies.

Considering the patient-associated studies, the highest proportion were literature reviews (18/72), followed by 5 systematic reviews, 1 meta-analysis and 22 observational studies of a cross-sectional, cohort or case-control nature. In addition, there was one interventional randomized controlled study. Fig. 3 provides an overview of the types of cancer studies reported by the LAU directory. Notably, two studies specifically targeted fetal cancer and metastasis, and involved pregnant women. Furthermore, five studies were conducted on the pediatric population.

The faculty at LAU conducted research on various types of cancer. Some of these studies specifically investigated new herbal treatments and examined their anticancer properties (7/72 publications). In total, 28 of the 72 publications examined multiple cancer types or cancer in general. The primary objectives of these studies were twofold: Firstly, to explore pharmacological mechanisms and highlight pathways for cancer prevention (39.1%); and secondly, to evaluate the psychological challenges associated with cancer (30.4%). One study specifically focused on the identification of potential risk factors associated with cancer (5). The remaining studies each focused on specific types of cancer, such as lung, breast, colon or brain cancer. The main objectives of these studies were to investigate the incidence, prevalence, treatment options and prevention mechanisms for these specific types of cancer. Studies that focused on understanding the regulatory functions of small RNAs and human recombinant arginase I in the treatment of cancer constituted only 4.16% of all publications and were all published in 2020 (25–27). Additionally, several in vitro studies were conducted, which examined either a variety of cancer types or specific types of cancer. More comprehensive information on the various types of cancer researched is presented in Fig. 4.

In the LAU dataset of 72 cancer publications, 38.89% covered all types of cancer, as indicated in Table I (18,28–53), while the remaining 61.11% focused on specific oncological types, as shown in Table II (10,17,19,20,25–27,54–90). These two tables provide additional information about each study, including its main focus, aim/purpose, study type, the type of cancer studied and key findings. Moreover, Figs. 5 and 6 depict the trends of cancer studies in terms of study types and types of cancer, respectively, across the years.

The aim of the present investigation was to assess the quantity and quality of cancer studies reported by the LAU and explore their respective objectives and areas of focus. The review encompasses in vitro, in vivo and animal studies. A relatively high number of literature reviews and a prevalence of observational studies over experimental ones were conducted. This finding may be expected since observational studies are generally easier to perform, more convenient and less stringent compared with interventional studies, although they carry a lower level of evidence (91).

The aims of the included studies varied, and in some cases it appeared that the main objective was solely descriptive. Therefore, it is essential to conduct more interventional, experimental and well-controlled human studies that possess higher external validity and generalizability. Such studies would lead to more definitive conclusions and trustworthy recommendations (92).

The present analysis reveals that researchers at the LAU who are interested in cancer have focused on a variety of research areas. The most common type of study involved laboratory experiments, namely in vitro studies, which accounted for more than one-third of the LAU studies. Animal models are important tools in cancer research in vitro and in vivo, as they can be used in the identification of carcinogens, development of cancer therapies and drug screening, and for providing insights into the molecular mechanisms of tumor growth and metastasis (93). In addition, they are easy to manipulate, homogenous, accessible and do not require human participants (94). The latter point was highlighted in the present study, which showed that this type of study was most prevalent during 2020-2021, during the era of COVID-19.

Special updates and reviews on novel anticancer therapies were also shown to be prevalent in the present study. Notably, these findings, particularly those concerning the regulatory roles of small RNAs, have provided new insights to improve the global understanding of cancer biology. Although these types of studies were the most prevalent during the year 2020, prior to the spread of COVID-19 and the economic crisis that impacted research funding negatively in Lebanon, in coming years, broader revelations about fundamental aspects of cellular biology are likely to increase our understanding of the aberrant behavior of cancer cells and notably contribute to the advancement of biomedical research (14). In addition to anticancer treatment, other studies had additional objectives, such as determining the incidence and prevalence of specific types of cancer, identifying risk factors associated with certain cancers and exploring their socio-economic and psychological impacts. Indeed, the diverse range of findings from these studies on cancer underscores the broad spectrum of interest of researchers to this field and emphasizes the requirement for well-balanced, patient-centric research strategies that can yield improved outcomes and higher cure rates (95).

Just a few decades ago, clinical investigators and physicians were often advised to refrain from engaging in oncology due to its complexity and the discouraging clinical outcomes it yielded. Additionally, conducting cancer research required significant financial investment and relied on patients dedicating their time and effort (96). Currently, the primary challenge lies in the development of fundamental research on cancer prevention and treatment to impede the occurrence of new cases and reduce the global incidence of cancer.

Although the annual output of cancer research appears to be low when compared with that of other publications on different research subjects, a sharp increase in the number of cancer publications was noticed during the years of 2018 and 2019 in the present study. This underlines the increased involvement of LAU scholars in research as the aim of expanding the number of publications and citations, as well as the support offered by the academic institution as an incentive, seems to have had a positive impact on the publication rate of papers on cancer. In fact, Boutros and Fakih (97) argued in their recent publication that the number of academic publications was associated with academic promotion across all institutional settings. The authors also concluded that the positive consequences of the number of publications of each faculty member suggests that this factor should be a priority for administrators to consider when making decisions regarding promotion. LAU is a leading private and nonsectarian higher education institution that operates under a charter from the Board of Regents of the University of the State of New York, and has a large publication volume relative to its faculty size, which makes it an ideal source of relevant information (98). In terms of quality, LAU provides incentives for researchers to publish their studies in the top 10% of international journals; thus, LAU is a research-active institution of higher learning in Lebanon and the region, with no compromise in its commitment to quality teaching (99). Moreover, the urgency of conducting cancer research has escalated due to the high prevalence of cancer worldwide, with approximately one in two individuals receiving a cancer diagnosis in their lifetime (100). Despite current treatments, cancer-associated mortality and morbidity rates remain high (6). This global situation mirrors the situation in Lebanon, as indicated by the 2021 report from the Global Cancer Observatory of the National Cancer Registry, which revealed an increase in cancer cases despite ongoing research on cancer (22). As a result, oncological research has garnered public funding and global monetary investments to incentivize clinical investigators to pursue cancer research (101).

Despite the aforementioned increase in cancer-associated publications, a reduction in the number of publications was observed in 2021. A possible explanation for this is the outbreak of the novel COVID-19 that has impacted all types of research in various forms (102,103). Another potential explanation is the lack of funds required for research in general imposed by the severe socio-economic Lebanese crisis and political instability manifested by unprecedented rates of unemployment, inflation and poverty, and a rapid devaluation of the Lebanese currency since the beginning of 2021 (104,105).

Research on breast and colorectal cancer was found to be the most prevalent among that on all types of cancer, accounting for >30% of all cancer studies. This finding is not unexpected since, according to previous studies, these types of cancer were the most prevalent in Lebanon during the last 5 years (22,106). Unfortunately, research on breast and colorectal cancers decreased in 2022 since Lebanon was continuing to face a serious economic crisis with an effect on fiscal and human resources.

Reflecting upon the approaches to cancer research outlined in the present study, it is necessary to highlight several further recommendations. First, it is essential to conduct more research using real-life data in order to accurately assess the actual impact of research on cancer incidence, treatment, outcomes and prevention techniques. Additionally, there is a requirement for more clinical studies involving the users and beneficiaries of cancer research, such as patients and their families. It would be beneficial for these studies to involve a greater representation of individuals from real-world populations, with the development of a prospective study plan to establish specific targets for trial enrolment based on disease epidemiology and incidence. Moreover, it is crucial to allocate more robust, sustained and predictable funding for additional clinical and translational longitudinal molecular profiling studies in large and diverse cohorts of patients with cancer. This will aid in understanding the natural progression of cancers and exploring the role of biology and genetics in cancer health disparities. Furthermore, the national public health workforce should prioritize cancer control initiatives that aim to reduce the incidence, morbidity and mortality of cancer. These initiatives may also focus on improving the quality of life for individuals with cancer by implementing evidence-based interventions for prevention, early detection, diagnosis and treatment. Additionally, it is important to develop well-planned strategies to guide future cancer research.

The issue of cancer research studies being underrepresented or misrepresented is an important factor contributing to therapy delays and proactive measures are required to address this. The importance of the present review lies in its summary of the different cancer studies that were conducted in an academic university during a 5-year period. The review has shown that cancer research is an attractive topic for many academic researchers; however, the spread of COVID-19 and the economic crisis had a major impact on this type of research, which might have contributed to a shift in study types towards more observational or in vitro studies as well as a remarkable reduction in research output, particularly after the spread of COVID-19 in 2020. From this perspective, it is essential to emphasize that researchers must re-focus their efforts on conducting studies associated with cancer, since cancer research should be recognized as one of the most prevalent health concerns, as is COVID-19. To develop new therapies, gain a deeper understanding of cancer prognosis and survivorship and ensure the availability of new drugs in all healthcare settings, a collaborative effort involving the diverse cancer research community in each country is necessary. Translational cancer research, particularly interventional or experimental human studies, is recommended to be an integral part of the delivery of oncology care, ensuring that valuable knowledge is gained in academic institutions and nationally. For this reason, policy proposals should be made to enhance access to digital healthcare, expand healthcare programs, allocate funds for experimental cancer research and provide financial support to healthcare institutions. Moreover, interventional studies that focus on anticancer therapy should be the primary interest of pharmaceutical companies as well as research centers since, according to the present results, only a few of these were conducted.

It is important to emphasize that the impact of cancer research can be amplified when organizations use a multidisciplinary approach, as demonstrated by the diversity of studies in the present review, which can guide and enhance future evaluations.

At present, scientists seldom contemplate an ultimate cure for cancer. However, further research on the short-term and long-term effects of current cancer therapies is necessary. For instance, efforts can be made to address the psychological and socioeconomic challenges faced by cancer patients during their treatment, or to find methods of mitigating the potential side effects experienced during therapy. By combining technological advancements with ongoing operational research, the field of oncology will be able to move on from the era when surgery and chemotherapy were the sole treatment options available.