Access to advanced cancer care services in the West Bank-occupied Palestinian territory

Abstract

IntroductionUniversal Health Coverage (UHC) identifies the provision of palliative care for people with advanced disease as an essential health service. Palliative care is also stipulated as a human right under existing covenants. Oncology services provided by the Palestinian Authority under Israeli military occupation are limited to surgery and chemotherapy treatment. Our study aimed to describe the experiences of patients with advanced-stage cancer in the West Bank in accessing oncology services and meeting their health care needs.MethodologyWe conducted a qualitative study among adult patients diagnosed with advanced lung, colon, or breast cancer in three Palestinian governmental hospitals, and with oncologists. Thematic analysis was conducted on the verbatim interview transcripts.ResultsThe sample consisted of 22 Palestinian patients (10 men and 12 women) and 3 practicing oncologists. The findings reveal that cancer care is fragmented, with limited access to the services needed. Patients face referral delays in accessing treatment which worsen their health condition in some cases. Some patients reported difficulties in getting Israeli permits to access radiotherapy treatment in East-Jerusalem, and others experienced interruptions of their chemotherapy treatment sessions due to the unavailability of chemotherapy medications caused by Israeli-side delays. Other reported problems were related to the Palestinian health system and service delivery and quality, including fragmentation of services, infrastructure issues, and unavailability of medications. Advanced diagnostic services and palliative care are almost absent at Palestinian governmental hospitals, and patients need to seek these services in the private sector.ConclusionThe data demonstrate specific access restrictions to cancer care in the West Bank due to Israeli military occupation of Palestinian land. This affects all stages of the care pathway, from restricted diagnosis services, to limited treatment and then poor availability of palliative care. Cancer patients will continue to suffer if the root causes of these structural constraints are not addressed.

Barriers to access to cancer care for patients from the conflict-affected region of the Nagorno-Karabakh Republic: A qualitative study

“…Barriers to cancer care and psychosocial support services, physical and financial hardship endured by cancer patients in our study and other studies from similar contexts [ 7 , 19 – 22 ] are concerning. Cancer treatment requires a multimodal approach, starting with timely diagnosis and person-centred treatment, yet our study and previous studies report many obstacles faced by cancer patients along the continuum of cancer care pathways.…”

“…Cancer treatment requires a multimodal approach, starting with timely diagnosis and person-centred treatment, yet our study and previous studies report many obstacles faced by cancer patients along the continuum of cancer care pathways. This is a recurring problem in conflict-affected contexts, where healthcare infrastructure and supply chains are often compromised [ 4 , 6 , 7 , 19 – 23 ]. For instance, a recent study found that Palestinian patients with advanced-stage cancer in the West Bank experienced referral delays in accessing treatment as well as going through unpredictable, lengthy processes of obtaining Israeli permits to access cancer care in East Jerusalem [ 19 ].…”

“…This is a recurring problem in conflict-affected contexts, where healthcare infrastructure and supply chains are often compromised [ 4 , 6 , 7 , 19 – 23 ]. For instance, a recent study found that Palestinian patients with advanced-stage cancer in the West Bank experienced referral delays in accessing treatment as well as going through unpredictable, lengthy processes of obtaining Israeli permits to access cancer care in East Jerusalem [ 19 ]. The refusal or delay of Israeli permits contributed to delays in treatment, affecting patient health outcomes.…”

“…A recent study projecting the impacts of the war in Ukraine on cancer patients argues that armed conflicts increase the risk of both developing cancer and other health-related comorbidities and complications, divert resources away from cancer care, and lead to delays in diagnosis due to competing priorities [ 7 ]. Evidence from multiple sources suggests that behavioural changes, delays to presentation, the availability of timely and affordable complex care, lack of access to facilities and infrastructure, shortage of essential medicines and medical equipment, financial hardship, loss of family structure and support, war-related stress and uncertainty about future are the key obstacles faced by cancer patients in conflict-affected regions [ 6 , 7 , 19 – 23 ]. There is an urgent need to mobilise humanitarian organisations and governments across the world to ensure cancer patients and their households’ safety and facilitate rapid access to care and support services.…”

Adherence to the evidence-based recommendations in managing bone health, pain, and mobility of patients with multiple myeloma: a mixed method in the Palestinian healthcare system

“…Adherence to the recommended guidelines for diagnosing patients with multiple myeloma was 98%. In Palestine, caring for cancer patients has long been described as fragmented [ 52 , 53 ]. Lack of coordination between hematologists-oncologists, radiologists, pathologists, and surgeons was previously reported [ 52 ].…”