Cancer center leadership during large-scale crises: a practical evidence-informed framework with perspectives from...

Cancer centers are disproportionately vulnerable to large-scale crises-including pandemics, armed conflicts, cyberattacks, and supply chain failures-and while COVID-19 generated valuable crisis guidance for oncology, frameworks tailored to the specific structural vulnerabilities of GCC cancer systems have been limited. The Gulf Cooperation Council region illustrates this gap with immediate, real-time urgency. The ongoing 2026 regional military escalation has reportedly disrupted Strait of Hormuz shipping and Gulf air cargo routes-critical corridors for pharmaceutical cold-chain logistics across all six GCC states-posing risks to essential oncology pharmaceuticals, radioisotopes used in nuclear medicine, and CAR-T manufacturing supply chains. Cancer incidence across the GCC is projected to increase by 60% by 2040, and cancer care remains under-integrated into emergency preparedness frameworks globally. This Perspective proposes a six-pillar crisis leadership framework for cancer center directors and oncology leaders, organized across a four-phase crisis lifecycle (Prepare, Respond, Adapt, Recover), drawing on pandemic-era oncology evidence, international oncology society guidelines, and contextual analysis of the 2026 GCC crisis. The six pillars address the full operational spectrum of cancer center crisis management, from triage and pharmaceutical resilience to workforce wellbeing, digital health, and cross-border coordination. Three specific policy recommendations for GCC health systems are proposed: a formal GCC Oncology Crisis Network with a Regional Real-Time Pharmaceutical Dashboard and distributed reserve framework spanning UAE, Saudi Arabia, and Oman; domestic manufacturing investment for oncology essentials; and a GCC oncology resilience research agenda.