Cancer care in Pakistan: a national survey of infrastructure, diagnostic capacity, therapeutic access, and workforce...

Pakistan, a lower-middle-income country of some 241 million people, faces a rising cancer burden - an estimated 185,748 new cancer cases and 118,631 cancer deaths in 2022 - that is served by a heterogeneous and largely uncoordinated mix of public, private for-profit, philanthropic, and Atomic Energy Commission cancer facilities. Nationally representative data on oncology infrastructure, diagnostic capacity, therapeutic access, and workforce conditions remain limited. We surveyed oncology professionals to describe, from their perspective, the capabilities of their institutions and their own working conditions.

A cross-sectional survey was completed by 111 oncology professionals practising across ten cities in four provinces between July and September 2025. A structured questionnaire captured institutional infrastructure, diagnostic and molecular testing, multidisciplinary practice, therapeutic availability, supportive services, research activity, financial constraints, and workforce perspectives. Data were analysed descriptively with the individual respondent as the unit of analysis. Institutional sector (private, government, or Atomic Energy Cancer Hospital) was assigned post hoc from each respondent's known institutional affiliation and compared using the χ² test with Freeman-Halton exact confirmation.

Respondents comprised radiation/clinical (55.9%), medical (25.2%), and surgical (18.9%) oncologists; 81.1% practised in academic teaching hospitals, and two cities (Karachi and Lahore) accounted for 66.6% of respondents. Computed tomography was reported by 99.1% and positron-emission tomography by 57.7%; next-generation sequencing was reported by 61.3%, although most of these respondents indicated that fewer than half of their patients could afford it. Immunotherapy was reported at 76.6% of settings and dedicated palliative care at 39.6%. Financial barriers were reported by 94.6% of respondents, and only 27.9% were satisfied with their compensation. In exploratory sector comparisons, radiotherapy infrastructure was concentrated in Atomic Energy hospitals, whereas reported resource shortages rose from private (47%) through Atomic Energy (73%) to government (92%) settings.

Respondents described an oncology system with foundational strengths concentrated in a few urban academic centres, alongside limited advanced diagnostics, sparse supportive care, and pervasive financial barriers. As what is, to our knowledge, the first structured national survey of its kind, and a descriptive, self-reported one, these findings map perceived gaps rather than verified service levels or patient outcomes, and are intended to provide a baseline that informs - not substitutes for - formal national cancer-capacity assessment and planning.