The state of cancer research and its association with the cancer burden in Ecuador: a bibliometric study

Abstract

Purpose

Cancer has emerged as a major public health concern in Ecuador, reflecting global trends. Thus, it is imperative to understand the country´s cancer research landscape. We aim to conduct a bibliometric analysis of Ecuadorian cancer research publications from 2008 to 2021 to identify research trends, institutional contributions, international collaborations, and the association with the national cancer burden.

Methods

Articles were retrieved from Scopus, PubMed, and LILACS databases. Descriptive statistics and chi-square tests were employed to analyze different bibliometric indicators.

Results

A marked increase in cancer-related research output was observed, particularly after 2014. The most common study designs were case reports (n = 244, 30.7%), cross-sectional studies (n = 174, 21.9%) and review articles (n = 131, 16.5%). Universities were the main contributors to national cancer research, accounting for 32.4% (n = 256) of all publications, with private institutions more frequently publishing in higher-ranked journals. Collaborative efforts between universities and hospitals represented 25.3% (n = 200) of publications, though 45.1% of these were indexed in the lowest SCImago Journal Rank quartile (Q4). The most frequently studied cancer types by body location/system were gastrointestinal, gynecologic, and breast cancer. This trend contrasts with national cancer statistics reported in 2022, in which the most common cancer types were breast, prostate (genitourinary), and stomach (gastrointestinal) cancers.

Conclusion

Our study provides a comprehensive overview of oncology research in Ecuador over a 14-year period. While research output has increased, there remains a need to enhance research quality and ensure closer alignment with the country’s primary cancer burdens to better inform national cancer control strategies.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12672-025-03168-w.

Introduction

Cancer has emerged as one of the most significant global health challenges, accounting for approximately one in every six deaths worldwide [1]. According to global cancer statistics from 2022, an estimated 20 million new cancer cases and 9.7 million cancer-related deaths were reported that year [2]. In Latin America and the Caribbean (LAC), cancer is also a leading cause of mortality, with approximately 1.5 million new cases and 700,000 deaths reported in 2020. If current trends persist, the cancer burden in the region is projected to rise by 67%, reaching an estimated 2.4 million new cases annually by 2040 [3], underscoring the considerable health burden cancer imposes on the region. This scenario is accelerated due to the rapid aging phenomenon that LAC countries are experiencing. For example, in many countries in the region, the proportion of people over 65 years has doubled in less than 30 years [4]. The literature predicts a 140% increase in the incidence of new cancer cases among older adults in LAC between 2012 and 2035 [5].

Ecuador reflects this regional and global trend. According to the Global Cancer Observatory of the World Health Organization (WHO), the country reported 30,888 new cancer cases and 16,158 cancer-related deaths in 2022 [6]. These rates are expected to increase in the coming years. Among men, the most frequently diagnosed cancers are prostate, stomach, colorectal, non-Hodgkin lymphoma, and lung cancer. In women, breast, cervical, colorectal, stomach and thyroid cancers are the most prevalent [6]. Many of these cancer types are linked to preventable infections and modifiable risk factors, underscoring the urgent need for effective public health policies and evidence-based prevention strategies, both of which require a solid foundation of scientific research.

Despite the growing cancer burden, limited information is available on Ecuador’s scientific output in this field. A study published in 2024 revealed that only 18.54% of the country’s health sciences research was aligned with its leading causes of mortality, suggesting a potential disconnect between national research priorities and the country’s most pressing public health needs [7].

This study aims to analyze Ecuador’s scientific production related to cancer between 2008 and 2021. To achieve this, we conducted a bibliometric analysis to examine the structure, evolution, and thematic focus of the country’s cancer research. Bibliometric methods offer a quantitative assessment of research activity, enabling the identification of trends, gaps, and strengths within a specific field [8]. By providing insights into Ecuador’s cancer research landscape, this analysis can inform future strategies to enhance the alignment between scientific output and national health priorities, ultimately contributing to more effective public health interventions.

Methods

To conduct the bibliometric analysis, we utilized three different databases: Scopus, PubMed, and LILACS to identify all cancer-related publications affiliated with Ecuador from 2008 to 2021. To ensure robust and comprehensive retrieval of articles published in English, we selected Scopus, considered the world’s second-largest citation database [9], and PubMed. To complement these databases and capture literature published in Spanish, we also included LILACS, which indexes scientific health literature from LAC countries. Although LILACS primarily includes literature in Spanish and Portuguese, it employs the Descriptores en Ciencias de la Salud (DeCS) system, a derivative of the Medical Subject Headings (MeSH) adapted to Latin American (LA) contexts [10]. Most LILACS-indexed articles contain abstracts and keywords in both Spanish and English. Therefore, to maintain consistency with the search strategies used in Scopus and PubMed, facilitate cross-database comparability, and optimize the retrieval of relevant and standardized information, we applied search terms exclusively in English.

Search strategy and selection criteria

We utilized MeSH from the National Library of Medicine (NLM) to capture all vocabulary related to the term ‘cancer.’ Using the identified terms, we formulated the following query string: (TITLE-ABS-KEY (“Neoplasia” OR “Neoplasias” OR “Neoplasm” OR “Tumor” OR “Tumors” OR “Cancer” OR “Cancers” OR “Malignancy” OR “Malignancies” OR “Malignant Neoplasms” OR “Malignant Neoplasm” OR “Neoplasm, Malignant” OR “Neoplasms, Malignant” OR “Benign Neoplasms” OR “Neoplasms, Benign” OR “Benign Neoplasm” OR “Neoplasm, Benign”) AND AFFILCOUNTRY (“Ecuador”)) AND PUBYEAR > 2007 AND PUBYEAR < 2022. The cut-off date for record search was 24/03/2022.

Data extraction

All identified records were screened using the Rayyan software (https://www.rayyan.ai/) [11], an automation tool designed to facilitate systematic reviews by identifying and removing duplicate articles. After duplicates were eliminated, the remaining records were assessed based on their titles and abstracts. Articles were excluded if they were not related to human cancer or if cancer was not the primary focus of the study. Subsequently, a full-text review was conducted to determine final eligibility.

Inclusion criteria were based on author affiliation: only articles in which at least one author was affiliated with an Ecuadorian institution were included. To determine whether an author with Ecuadorian institutional affiliation was a foreign researcher, we examined author names and institutional profiles when necessary. Publications in which the Ecuadorian affiliation belonged exclusively to foreign authors were excluded, as our aim was to evaluate scientific output that reflects national research capacity and the contributions of Ecuadorian scientists. This distinction was important to avoid overestimating domestic research production by including work led by international researchers temporarily affiliated with Ecuadorian institutions.

Additional inclusion criteria were full-text availability and article type; only original research articles, review articles, short reports, case studies, and conference papers were included. Although conference papers are not always considered full original research, they were included in our analysis because they often reflect preliminary findings or early-stage results presented by Ecuadorian scientists. In countries with relatively lower research output, such as Ecuador, these publications can provide a more comprehensive overview of national scientific capacity. Discrepancies during the screening process were resolved by consensus among all authors.

We created a data extraction matrix to systematically collect and organize relevant information from the selected articles. The following variables were recorded: (i) institutional affiliation; (ii) province of affiliation; (iii) presence of international collaboration; (iv) country of affiliation of international co-authors; (v) oncologic research approach (focused on malignant neoplasms, benign neoplasms, general cancer research or both malignant and benign neoplasms); (vi) cancer types categorized by body location/system; (vii) cancer research area; (viii) origin of data or sample; (ix) type of data or sample (human-related, database/literature-based, plant extracts or other); (x) study design; (xi) research category (clinical, basic science, population health, translational or mixed); (xii) language of publication; and (xiii) SJR quartile classification (https://www.scimagojr.com/) [12].

In addition, cancer types were categorized based on the classification system of the National Cancer Institute (NCI) at the National Institutes of Health (NIH), which organizes cancers by body location/system [13]. The main categories included breast, gastrointestinal, endocrine, eye, genitourinary, gynecology, head/neck, hematologic, musculoskeletal/soft tissue, neurologic, respiratory/thoracic, and skin. Further subclassifications based on specific anatomical locations within each category are detailed in online supplementary Table 1.

Data analysis

The baseline characteristics of the retrieved cancer-related articles were summarized using descriptive statistics, including frequencies and percentages. Associations between categorical variables were examined using the Chi-square test. All statistical analyses were performed using Minitab Statistical Software, Version 22.1.0. Additionally, a two-tailed p-value of < 0.05 was considered statistically significant.

Results

Research articles identified

Using our predefined search strategy, we identified a total of 1917 articles: 886 from Scopus, 653 from PubMed, and 378 from LILACS. After removing duplicates and screening titles and abstracts, 933 articles were selected for full-text review. Of these, 138 were excluded based on our eligibility criteria, resulting in a final dataset of 795 articles for analysis (Fig. 1).

Fig. 1.

Identification of cancer research articles via databases. Flow diagram adapted from PRISMA 2020. Cut-offdate for record search: 24/03/20

General characteristics of Ecuadorian cancer research publications

Table 1 summarizes the general characteristics of the included cancer-related publications. Of the 795 articles analyzed, the majority (n = 514; 64.7%), were published in Scopus-indexed journals. Regarding the language of publication, Spanish (n = 386; 48.6%) and English (n = 382; 48.1%) were used almost equally by Ecuadorian researchers to communicate their findings. Notably, a substantial proportion of the articles (n = 455; 57.2%) did not involve international collaboration.

Table 1.

General characteristics of Ecuadorian cancer research publications

Period 2008–2021		Number of articles n = 795
Article indexing, n (%)	Scopus indexed journals	514 (64.7)
	Scopus non-indexed journals	281 (35.3)
Article publication language, n (%)	Spanish	386 (48.6)
	English	382 (48.1)
	English and Spanish	24 (3.0)
	Portuguese	3 (0.4)
International collaboration, n (%)	No	455 (57.2)
	Yes	340 (42.8)
Origin of the data or sample, n (%)	Ecuador	480 (60.4)
	Unknown or from other countries	273 (34.3)
	Ecuador and other countries	42 (5.3)
Type of data or sample, n (%)	Human-related*	548 (68.9)
	Database/literature-based**	201 (25.3)
	Plant extracts***	30 (3.8)
	Other****	16 (2.0)
Oncologic research approach, n (%)	Malignant neoplasms	578 (72.7)
	Benign neoplasms	120 (15.1)
	General cancer research	79 (9.9)
	Malignant and benign neoplasms	18 (2.3)
Research category, n (%)	Clinical research	577 (72.6)
	Basic science	114 (14.3)
	Population health research	95 (11.9)
	Mixed*****	8 (1.0)
	Translational (basic science + clinical research)	1 (0.1)
Cancer research area, n (%)	Detection and Diagnosis	322 (40.5)
	Treatment	247 (31.1)
	Epidemiology	84 (10.6)
	Biology and Genomics	60 (7.5)
	Etiology	36 (4.5)
	Prevention	19 (2.4)
	Public Health	16 (2.0)
	Health Disparities	11 (1.4)

*Articles that used biological samples, clinical data, genomic data, imaging data, etc. **This includes literature reviews and computational studies. ***Articles that evaluate the cytotoxic potential of plant extracts against human cancer cell lines. ****Primarily, articles that assessed human health risk based on environment-related data (e.g., exposure to metallic contaminants). *****Articles that encompass a mixture of basic science, clinical research, and population health research.

In relation to the origin and type of the data or sample, 480 articles (60.4%) were based on data from Ecuador, while 548 publications (68.9%) utilized human-related samples, including biological specimens, clinical data, genomic data, and imaging data. Additionally, a small subset of studies (n = 30; 3.8%) investigated the cytotoxic potential of plant extracts against human cancer cell lines.

Most studies (n = 578; 72.7%) focused on malignant neoplasms, while only 18 articles (2.3%) examined both malignant and benign neoplasms. The predominant research category was clinical research (n = 577; 72.6%), followed by basic science (n = 114; 14.3%) and population health research (n = 95; 11.9%). Additionally, the most frequently studied cancer research areas were detection and diagnosis (n = 322; 40.5%), treatment (n = 247; 31.1%), and epidemiology (n = 84; 10.6%).

Among clinical research publications, case report studies were the most prominent study designs (n = 243; 42.1%), with a strong emphasis on the detection and diagnosis of rare or unusual cancers. In contrast, laboratory research was the most common study design in basic science publications (n = 68; 59.6%), with a marked focus on evaluating plant extracts (e.g., strawberries or berberine derivatives) for their cytotoxic effects on human cancer cell lines. Within population health research, the majority were cross-sectional studies (n = 59; 62.1%), primarily focused on the prevalence and distribution of human papillomavirus (HPV) genotypes.

Cancer research over time

Figure 2 illustrates the annual distribution of cancer-related publications in Ecuador from 2008 to 2021, categorized by study design. In the first half of the period (2008–2014), research output remained relatively low, with annual publications ranging from 6 to 19. A notable increase occurred in 2015, when the number of publications jump to 55, marking a turning point in the country’s cancer research trajectory. The upward trend continued, reaching a peak in 2021 with 134 publications. That year, cross-sectional studies (n = 36) and literature reviews (n = 30) made the largest contributions. Overall, most of the Ecuadorian cancer research production across the entire study period consisted of case report studies (n = 244; 30.7%), cross-sectional studies (n = 174; 21.9%) and review articles (n = 131; 16.5%) (Fig. 2).

Fig. 2.

Cancer research and distribution of different types of study designs over time

Geographic distribution of affiliations and cancer types by province

Figure 3 presents the geographic distribution of institutional affiliations by province, alongside the most frequently reported types of cancer in each region. Pichincha registered the highest number of institutional affiliations (n = 259), with predominant research on gastrointestinal, breast, gynecologic, and genitourinary cancers. Guayas followed with 176 affiliations, displaying a similar research focus that included gastrointestinal, breast, gynecologic, and hematologic cancers. Azuay ranked third (n = 76), with gynecologic cancers being the most studied, followed by gastrointestinal, hematologic, and breast cancers. Several provinces, including Pastaza, Cañar, Sucumbíos, Morona Santiago, Bolívar, Santo Domingo de los Tsáchilas, Cotopaxi, Esmeraldas, Los Ríos, and Napo, reported limited research activity with only 1 to 3 affiliations and no dominant cancer type studied. Notably, Santa Elena, Zamora Chinchipe, Orellana, Carchi and Galápagos had no recorded institutional affiliations for cancer research during the 14-year study period.

Fig. 3.

Number of affiliations by province and most reported types of cancer in each

Contribution of Ecuadorian institutions to cancer research

Table 2 summarizes the contributions of Ecuadorian institutions to national cancer research output. We found that universities, both public and private, emerged as the primary contributors of cancer research, collectively accounting for 32.4% (n = 256) of all publications. Public universities contributed 124 articles (15.7%) of which 75.8% were indexed in Scopus. These were distributed across all SJR quartiles, with 25.5% appearing in Q1 and 27.7% in Q4 journals. On the other hand, private universities published slightly more articles (n = 132; 16.7%) and exhibited a higher Scopus indexing rate (85.6%). Their publications were more frequently found in higher-impact journals, with 32.7% in Q1 and 31.0% in Q2.

Table 2.

Contribution of Ecuadorian institutions to cancer research

					SCImago journal rank quartile*				Chi-square test
Institution type		Number of articles** (n = 790)	Articles indexed in scopus		Q1 (%)	Q2 (%)	Q3 (%)	Q4 (%)	P-Value***
Universities, n (%)	Public	124 (15.7)	94 (75.8)		24 (25.5)	14 (14.9)	17 (18.1)	26 (27.7)	0.04
	Private	132 (16.7)	113 (85.6)		37 (32.7)	35 (31.0)	21 (18.6)	20 (17.7)
Hospitals, n (%)	Public	32 (4.1)	21 (65.6)		3 (14.3)	3 (14.3)	1 (4.8)	14 (66.7)	< 0.001
	Private	31 (3.9)	25 (80.6)		2 (8.0)	10 (40.0)	7 (28.0)	6 (24.0)
	Mixed****	127 (16.1)	61 (48.0)		25 (41.0)	12 (19.7)	13 (21.3)	10 (16.4)
Others, n (%)	Research institutes, clinical centers, etc.	31 (3.9)	26 (83.9)		12 (46.2)	4 (15.4)	7 (26.9)	3 (11.5)	-
Collaborations between institutions, n (%)	Public + Private Universities	27 (3.4)	21 (77.8)		6 (28.6)	5 (23.8)	3 (14.3)	7 (33.3)	-
	Public + Private Hospitals	2 (0.3)	2 (100.0)		0 (0)	0 (0)	0 (0)	2 (100.0)
	Public + Mixed Hospitals	18 (2.3)	5 (27.8)		1 (20.0)	0 (0)	0 (0)	4 (80.0)
	Private + Mixed Hospitals	13 (1.6)	10 (76.9)		0 (0)	0 (0)	2 (20.0)	8 (80.0)
	Universities + Hospitals	200 (25.3)	102 (51.0)		10 (9.8)	15 (14.7)	30 (29.4)	46 (45.1)
	Universities or Hospitals + Others	53 (6.7)	30 (56.6)		7 (23.3)	6 (20.0)	7 (23.3)	10 (33.3)

* SCImago Quartile data is only available for Journals and Book Series. Some conference papers indexed in Scopus (n = 15, 2.9%) were not part of a book series; therefore, they did not have an assigned quartile and were excluded from the analysis.

**The institution type of 5 articles could not be determined because the Ecuadorian authors were part of research collaborative groups.

***P-value of <0.05 was considered statistically significant.

****Hospitals that are managed by private entities but also receive financial support or subsidies from the state.

Hospitals also played a significant role, contributing 24.1% (n = 190) of the total publications. Among them, we identified that public hospitals accounted for 32 articles (4.1%), with a Scopus indexing rate of 65.6%, the majority of which were published in Q4 (66.7%) journals. In contrast, private hospitals produced a similar number of articles (n = 31; 3.9%) but achieved a higher indexing rate of 80.6%, with most indexed articles in Q2 (40.0%) journals. Mixed hospitals generated the highest volume of publications among hospital types (n = 127; 16.1%) but had the lowest indexing rate (48.0%). Nonetheless, a significant portion of their indexed publications appeared in Q1 journals (41.0%).

Collaboration between universities and hospitals emerged as a particularly productive model, resulting in 200 publications (25.3%). Although this group exhibited a moderate indexing rate (51.0%), a significant share of these publications were classified in Q4 (45.1%) journals.

Chi-square tests confirmed a statistically significant association between the type of institution and the SJR quartile of publication. For universities, the association was significant (p = 0.04), while for hospitals, the association was highly significant (p < 0.001), indicating that institutional type influences both the quantity and quality (as measured by journal quartile) of cancer research output in Ecuador.

International collaboration network and impact on Ecuadorian cancer research

Figure 4 illustrates the international collaboration network among countries that co-authored cancer research publications with Ecuadorian authors. Spain emerged as a major collaborator, represented by a prominently sized node, indicating a substantial number of joint publications. The United States also appeared as major partner, with a large node and extensive links to various countries across LA, Europe, and Asia, highlighting its broad engagement in global research collaboration.

Fig. 4.

International collaboration network

Within LAC, several countries demonstrated notable collaboration with Ecuador. Mexico, Colombia, Chile, and Brazil stood out as the most frequent regional partners. Additionally, countries such as Cuba, Venezuela, Argentina, Peru, and Uruguay, despite of having smaller nodes sizes compared to the leading collaborators, still played significant roles in fostering regional scientific cooperation. This network visualization underscores the significance of both global and intra-regional partnerships in advancing cancer research in Ecuador.

Overall, the collaborative work with international partners led to the production of studies with a higher level of evidence, such as randomized controlled trials (n = 6), meta-analyses (n = 5), and laboratory research (n = 81). International collaboration also catalyzed a higher proportion of publications in Scopus-indexed journals compared to non-collaborative projects (59.1% vs. 40.9%; p<0.001). Furthermore, publications involving international collaborators were significantly more likely to be published in higher-impact journals. Specifically, among the articles published in Q1 journals, 93.1% (n = 121) had international co-authorship compared to only 6.9% (n = 9) without such collaboration (Table 3).

Table 3.

Impact of international collaboration on Ecuadorian cancer research

Variable		International collaboration		Chi-square test
		Yes (n = 340)	No (n = 455)	P-Value*
Study design, n (%)	Case report studies	46 (18.9)	198 (81.1)	<0.001
	Cross-sectional studies	62 (35.6)	112 (64.4)
	Review articles	80 (61.1)	51 (38.9)
	Laboratory research	81 (75.7)	26 (24.3)
	Cohort studies	47 (51.1)	45 (48.9)
	Case-control studies	6 (30.0)	14 (70.0)
	Ecological studies	3 (37.5)	5 (62.5)
	Randomized controlled trials	6 (85.7)	1 (14.3)
	Qualitative studies	4 (57.1)	3 (42.9)
	Meta-analysis	5 (100.0)	0 (0)
Articles indexing, n (%)	Scopus indexed journals	304 (59.1)	210 (40.9)	<0.001
	Scopus non-indexed journals	36 (12.8)	245 (87.2)

		n = 294	n = 205
SCImago Journal Rank Quartile**, n (%)	Q1	121 (93.1)	9 (6.9)	<0.001
	Q2	73 (69.5)	32 (30.5)
	Q3	54 (50.0)	54 (50.0)
	Q4	46 (29.5)	110 (70.5)

*P-value of <0.05 was considered statistically significant.

** SCImago Quartile’s data is only available for Journals and Book Series. Some conference papers indexed in Scopus (n = 15, 2.9%) were not part of a book series; therefore, they did not have an assigned quartile and were excluded from the analysis.

Cancer types by body location/system

Among the articles that focused on a single type of malignant neoplasm (n = 520), the five most frequently studied cancer types by body location/system were gastrointestinal cancers (n = 121; 23.3%), followed by gynecologic cancers (n = 83; 16.0%), breast cancer (n = 82; 15.8%), hematologic cancers (n = 53; 10.2%), and genitourinary cancers (n = 38; 7.3%) (Fig. 5).

Fig. 5.

Cancer types by body location/system. Of the 578 articles that addressed malignant neoplasms, 520 focused on a single type of neoplasm, while 58 investigated multiple types. The results presented here are based exclusively on the 520 articles that examined a single neoplasm

Randomized controlled trials (RCTs)

We identified a very limited number of RCTs (n = 7; 0.9%) (see online supplementary Fig. 1), the majority of which (n = 4) focused on cancer treatment. These studies addressed various aspects of clinical oncology, including: (i) the safety and tolerability of a fixed 600 mg subcutaneous dose of trastuzumab in patients with HER2-positive early breast cancer (EBC), which confirmed its suitability as an adjuvant therapy in combination with concurrent or sequential chemotherapy; (ii) the low inter-provider agreement in Intensive Care Unit triage for critically ill cancer patients, where both general and cancer-specific triage models demonstrated poor consensus; (iii) a Phase III clinical trial assessing adjuvant capecitabine following standard chemotherapy in early triple-negative breast cancer (TNBC), which did not show a statistically significant improvement in disease-free survival (DFS) for the overall population; and (iv) the evaluation of preoperative stimulation of the efferent loop with probiotics prior to ileostomy closure in patients undergoing surgery for colorectal carcinoma, where findings indicated no significant reduction in the incidence of postoperative ileus or length of hospital stay.

Discussion

Our study presents a comprehensive bibliometric analysis of Ecuadorian cancer research production over a 14-year period, providing valuable insights into the evolution of cancer research within the country. Our findings reveal a marked increase in the volume of cancer-related publications, particularly after 2014, accompanied by greater diversity in study designs (see Fig. 2). Furthermore, our results highlight the central role played by universities, mixed hospitals, and collaborative efforts between academic institutions and hospitals in advancing cancer research in Ecuador (see Table 2).

Comparison with other studies

The observed growth in Ecuador’s scientific production is consistent with prior studies [14, 15] and can be attributed to a series of reforms in higher education and research sectors that Ecuador has implemented since 2008. One of the pivotal milestones was Constituent Mandate No. 14, issued by the National Constituent Assembly, which sought to restructure the country’s higher education system by closing or transforming low-quality institutions that failed to meet minimum academic standards [16]. This reform laid the groundwork for the Organic Law of Higher Education (LOES, by its Spanish acronym), implemented in 2010, which introduced a new regulatory framework for quality assurance in Ecuador’s higher education system. LOES established mandatory processes for the evaluation, accreditation, and categorization of universities, reinforcing the focus on institutional excellence [17]. As highlighted by Sisa et al. [7, 18], the implementation of LOES and the emphasis on research in academic institutions have contributed to a sustained increase in publications, particularly in health-related fields.

Another important driver of this research growth could be the Prometeo program, launched in 2011. This government initiative aimed to strengthen national research capacity by recruiting foreign researchers and Ecuadorian scientists working abroad to collaborate with local universities and research institutions. By fostering knowledge exchange and capacity building, Prometeo could have boosted the country’s ability to generate high-quality research and publish in internationally recognized journals. This initiative also sought to the internationalization of Ecuadorian research and supported the development of more competitive research groups [19]. Rodríguez et al. [20] noted that such programs played a key role in increasing the number of publications indexed in Scopus and enhancing the visibility of Ecuadorian science.

Collectively, these efforts have fostered the emergence of a research-oriented academic environment in Ecuador. By significantly restructuring its higher education institutions to prioritize research, transparency, and quality assurance, Ecuador has taken important steps to address historical gaps in research capacity and infrastructure. As outlined by Velastegui-Hernández et al. [21] Ecuador’s higher education system is undergoing a significant transformative process, adapting to a dynamic global scientific landscape and positioning itself to meet future challenges through reforms, inclusive policies, and investments in technology.

Interestingly, while we found an overall increase in cancer-related publication output in Ecuador, the distribution across study design types remains uneven. The predominance of case reports, cross-sectional studies, and review articles throughout the study period suggests that many Ecuadorian institutions may still face significant challenges in developing and implementing more complex study designs, such as RCTs and other longitudinal studies. This is particularly concerning as RCTs are essential components to inform evidence-based medicine and play a crucial role in validating effective treatments [22]. The prevalence of descriptive and observational studies indicates that, although research output is expanding, there remains a substantial gap in the production of high-quality clinical and translational research. This scarcity of high-quality clinical trials could be explained by several reasons including the strong preference of local researchers for immediate results, the lack of sustainable funding, the long and cumbersome process of obtaining an ethical evaluation/approval of a research protocol, the lack of adequately trained clinical researchers, and the weak role of the government in stimulating and coordinating a vibrant research environment among Ecuador´s higher education institutions [23, 24].

This issue is not unique to Ecuador but reflects a broader regional trend. Cancer clinical trials are relatively scarce across LAC countries when compared to developed countries [25]. Despite their critical importance for generating robust clinical evidence, LAC countries encounter numerous barriers to conducting this kind of studies, including limited economic resources, political instability, language barriers, lack of skilled personnel, ethical and regulatory system obstacles [26]. These structural and systemic constraints continue to hinder the advancement of more sophisticated research designs in the region, underscoring the need for greater investment and support to strengthen local/regional research capacity-building.

Another important finding is that universities are the primary drivers of Ecuadorian cancer-related research, followed by hospitals (see Table 2). This aligns with the observations of Chavez and Gaybor [27], who reported that the scientific output of hospitals and health research centers has diminished in prominence compared to that of universities. While hospitals continue to contribute to research, the majority of the scientific production now originates from universities, underscoring their increasingly central role in Ecuador’s scientific landscape.

Although both Ecuadorian universities and hospitals have made substantial contributions to cancer research, notable disparities in the quality and impact of their publications were observed. Public universities generated a significant volume of research; however, a large proportion of these publications appeared in lower-impact journals, particularly those classified in the Q4 quartile of the SJR. In contrast, private universities (despite producing a comparable number of publications) more frequently published in higher-impact journals (Q1 and Q2). These differences suggest that institutional type influence not only research productivity but also the quality and visibility of scientific output, reflecting disparities in access to financial resources, infrastructure, skilled researchers, and research support.

Similarly, hospitals, both public and private, produced fewer publications than universities. Public hospitals had a higher proportion of articles in Q4 journals, whereas private hospitals showed greater representation in Q2 journals. Interestingly, mixed hospitals stood out by producing a substantial number of publications, many of which were published in Q1 journals. This may be attributed to the fact that these types of hospitals benefit from both public and private resources, which may provide them with improved infrastructure and research capabilities and potentially facilitating publication in higher-impact journals.

Beyond the individual contributions of these institutions, collaborative efforts between universities and hospitals also played a notable role in Ecuador’s cancer research output. These collaborations accounted for 25.3% of all publications. However, despite their quantitative relevance, they exhibited a moderate Scopus indexing rate (51.0%), and a significant proportion (45.1%) of their articles were published in Q4 journals. This indicates that while such partnerships contribute to the volume of research, they often fall short in terms of visibility and impact. Enhancing the quality of research emerging from these collaborations will be essential to ensure broader scientific relevance and influence. Targeted efforts to improve training, research funding, and institutional support may help strengthen the scientific output of these partnerships and increase their representation in higher-impact journals.

Despite the positive trends observed in Ecuadorian cancer-related publications during the analyzed period, important challenges persist. According to the International Agency for Research on Cancer (IARC), in 2022 the three most frequently diagnosed cancers in Ecuador across both sexes and all age groups were breast, prostate, and stomach cancer, while the leading causes of cancer-related mortality were stomach, prostate, and colorectal cancer, ranked first, second, and third, respectively [6]. These epidemiological patterns contrast with our findings (see Fig. 5), revealing a misalignment between research focus efforts and Ecuador’s cancer burden.

As emphasized by Sisa et al. [18] over the past century only 18.5% of Ecuador’s biomedical publications have aligned with its principal disease burdens [7]. This disconnect suggests that a substantial portion of research activity may not be adequately informing national health priorities. As a consequence, critical high-burden cancers may remain underrepresented in the local evidence base, limiting the development of context-specific clinical guidelines, delaying improvements in treatment protocols, and weakening prevention and early detection strategies. This research gap has implications not only for the quality of cancer care but also for the broader efficiency and equity of health resource allocation. Strengthening investment in cancer research that is aligned with local epidemiological realities is therefore crucial to improving outcomes and addressing the most pressing public health challenges in Ecuador and the broader LA region.

Notably, high-impact cancers such as breast and stomach appear underrepresented in Ecuador’s research output despite their substantial contributions to both incidence and mortality, this may impair the development and implementation of effective prevention strategies. Stomach cancer is strongly associated with modifiable risk factors and infectious agents such as Helicobacter pylori [28]. However, the current lack of targeted research limits the ability to design and promote evidence-based public health campaigns focused on risk reduction and infection control. Similarly, the underrepresentation of prostate and colorectal cancers in local research may constrain the development of early detection strategies tailored to Ecuador’s epidemiological context. In the absence of robust, locally generated evidence, screening guidelines may fail to effectively identify cases at early stages, leading to delayed diagnoses and poorer clinical outcomes.

Another major insight is that there was a significant association between international collaboration and study designs (see Table 3). Research groups with international partners were more likely to publish laboratory studies, RCTs, and meta-analyses (study designs typically considered more complex, resource-intensive, and methodologically rigorous), compared to groups without such collaborations. Additionally, articles involving international collaboration were significantly more likely to be indexed in Scopus than those produced without foreign co-authors. This suggests that international partnerships may facilitate publication in higher-impact, widely indexed journals. This trend is further supported by the high proportion of internationally co-authored articles published in higher SJR quartiles (Q1 or Q2), indicating a tendency toward more selective and prestigious publication venues.

Although we found that most cancer-related articles were published without international co-authors (57.2%) (see Table 1), it is crucial for Ecuadorian researchers to continue building and strengthening international research networks. International collaboration has consistently been linked to improved research quality, higher citation rates, and a greater likelihood of publication in high-impact journals. Several bibliometric studies support these conclusions. For instance, De Lima et al. [29] reported that international collaborations in palliative care research in South America were associated with increased scientific impact, enhanced funding opportunities, publication in more prestigious journals, and the use of more rigorous study designs. Similarly, Kohus et al. [30] demonstrated that medical and health science publications from Visegrad Group countries with international collaborators exhibited significantly higher scientific impact (as measured by journal impact factor and citation metrics) than those produced through national collaborations alone. These findings align with those of Wang et al. [31], who found that internationally co-authored papers not only receive more global citations but also gain greater visibility within the authors’ home countries. Collectively, this evidence highlights the pivotal role of international collaboration in enhancing research quality and visibility, and underscores the importance of fostering and expanding global research networks, particularly in countries like Ecuador seeking to strengthen their scientific contributions.

In this context, it is worth emphasizing that the network of international collaboration involving Ecuadorian authors is already extensive, with the United States and Spain emerging as the country’s principal research partners. These results also corroborate the findings of Chávez and Gaybor [27], who stated that Ecuadorian scientific production is highly dependent on international research networks, primarily composed of scientists from the USA and Spain. The reason that USA is a major collaborator with Ecuador may be attributed to its global scientific dominance and the large number of Ecuadorian students pursuing graduate degrees there [32], partially influence by the Fulbright program, which has served as a bi-national agreement between the USA and Ecuador since 1956 to facilitate academic, research, or teaching programs [33]. In contrast, Spain has a natural relationship with Ecuador, rooted in their shared history, language, and culture [32]. The shared language significantly eases collaboration and joint research publications, reducing the language barriers often encountered in partnerships with non-Spanish-speaking countries.

Public health implications and regional comparative analysis

Our study highlights significant gaps in cancer research in Ecuador, which has direct implications for local public policy. The lack of alignment between cancer research efforts and the most prevalent types of cancers affecting the Ecuadorian population suggests that existing public health strategies may not be sufficiently supported by scientific evidence. This disconnection underscores the urgent need for national cancer research agendas to prioritize the most common cancer types in the country, in order to develop effective prevention, diagnosis, and treatment strategies that are tailored to population needs. Moreover, with the global cancer burden expected to grow from 20 million to 35 million cases between 2022 and 2050 (a 77% increase) [2], addressing these disparities through focused research will be crucial for improving health outcomes and developing effective cancer control programs.

The misalignment observed in Ecuador reflects broader regional patterns across LA. The growth in cancer research output in Ecuador, particularly after 2014, parallels trends identified by Lewison et al. [34], who reported a notable increase in cancer research across LA between 2014 and 2019. However, despite this growth, Lewison et al. also found that many countries in the region continue to under-research cancer relative to its disease burden, revealing a widespread disconnect between research activity and the actual impact of cancer on public health [34].

Specifically, Lewison et al. noted that certain cancer types, such as lung, pancreatic, and esophageal cancers, remain underrepresented in research despite their high disease burden. This highlights a critical misalignment between research priorities and the cancers contributing most to the incidence and mortality in the region. Additionally, when comparing research outputs against economic capacity, the study showed that countries like Brazil, Chile, and Uruguay produced roughly twice the amount of cancer research expected based on regional trends yet still fell short when compared to European nations relative to their Gross Domestic Product (GDP). This suggests that even relatively wealthier countries in the region are not leveraging their full potential in cancer research [34]. This misalignment could be overcome by several initiatives, including strengthening and building a strong leadership role of the Ecuadorian Ministry of Health, which in turn would guide local cancer research priorities. This role should be done by using validated/tested models to prioritize local research needs, such as the Child Health and Nutrition Research Initiative method or the James Lind Alliance framework [35]. Another initiative that could help to correct the observed misalignment is the creation of a national grant program that ensures sustainable funding to address the leading causes of mortality in the country, such as the “INEDITA” program launched in 2018 by the Secretary of Higher Education, Science, Technology and Innovation of Ecuador [36].

Strengths and limitations of the study

A major strength of our study is that the analysis was not limited to metadata from documents published primarily in Scopus and PubMed. By including LILACS, which focuses on health sciences literature from LAC, we expanded our coverage to capture research outputs that may not be indexed into larger global databases like Scopus or PubMed. This approach allowed for the identification of additional Spanish-language publications, often underrepresented in global indexing platforms, thereby providing a more complete overview of Ecuadorian cancer research output. The integration of multiple databases ensured a broader retrieval of articles, making the analysis more robust and representative of the actual scientific output in the region. Nevertheless, our study has some limitations. First, we did not disaggregate data by sex and age, limiting the ability to analyze gender/age-specific trends in cancer research. Second, we did not evaluate the scientific impact of the publications using bibliometric indicators such as citation counts, h-index, or journal impact factor, which could provide a deeper understanding of the influence and visibility of Ecuadorian cancer research. Third, we did not assess whether these research outputs translated into practical outcomes, such as policy changes, clinical guidelines, healthcare improvements, or patent developments. This presents an opportunity for future research to explore the practical impact of Ecuadorian cancer research on the country’s healthcare system and broader scientific advancements.

Conculusion

Our study reveals substantial growth in cancer-related research in Ecuador over the past 14 years, with universities and mixed hospitals serving as the principal contributors of scientific output. The predominant study designs were observational studies, particularly case report studies, cross-sectional studies, and review articles. Clinical and basic science research emerged as the most common categories during the study period, and the most frequently studied cancers were gastrointestinal, gynecologic, and breast. However, our findings also underscore a persistent misalignment between research output and national cancer burden. High-impact cancers such as stomach, prostate, and colorectal, which contribute significantly to morbidity and mortality in Ecuador, appear to be underrepresented in the research landscape. Addressing this gap requires aligning research agendas with epidemiological priorities to better inform public health strategies and improve outcomes. In addition, efforts should focus on enhancing research infrastructure, promoting the development of more complex study designs (such as RCTs) and fostering international collaborations. Such initiatives will be essential for increasing the scientific quality, visibility, and practical impact of Ecuadorian cancer research, ultimately contributing to more effective cancer prevention, diagnosis, and treatment both nationally and within the broader LA region.

Author contributions

S.D Padilla-Sánchez: Data curation, Formal analysis, Investigation, Methodology, Visualization, Writing-original draft, Writing-review and editing. I. Espinosa: Data curation, Formal analysis, Investigation, Methodology, Writing-review and editing. I. Sisa: Investigation, Methodology, Writing-review and editing, Conceptualization, Supervision.

Funding

No funding was received for conducting this study.

Data availability

Available as per request to the corresponding author.

Declarations

Ethics approval

The present article did not require institutional review board approval because we do not report human participant data.

Consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.