Late presentation and suboptimal treatment of breast cancer among Syrian refugees: a retrospective study

Abdel‐Razeq, Hikmat; Tamimi, Faris; Abdel-Razeq, Nayef; El-Atrash, Maryam; Sharaf, Baha'; Mustafa, Rawan; Mansour, Razan; Bater, Rayan

doi:10.1177/03000605211018448

Cited by 17 publications

(23 citation statements)

References 13 publications

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“…12,13 There are little data on diagnostic delays in Syria; however, a study among Syrian refugees in Jordan noted that 65% presented with metastatic disease and as a result received delayed and suboptimal treatment. 14 A study from Konya province in Turkey reported on 230 adult and 38 children who are Syrian refugees diagnosed with cancer between 2005 and 2020. 15 They noted that 40% of patients had metastatic cancer at diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Cancer Diagnoses during Active Conflict: Experience from a Cancer Program in Northwest Syria

Atassi¹,

Tse

Mkhallalati

et al. 2022

Avicenna J Med

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Background Protracted conflict has destroyed Syria's health system with severe impacts on the diagnosis and treatment of chronic and high-cost diseases including cancer. Here, we review the type and (where possible) the stage of cancers diagnosed in a pathology laboratory serving Northwest Syria. Methods We retrospectively reviewed all pathology reports which reported a diagnosis of cancer from a pathology department in Northwest Syria from January to December 2020. Results A total of 397 new cancers were diagnosed during 2020 of which 191 were among males (48.1%) and 20 cases were in children aged 17 years or under (5%). The most common cancer in men was bladder cancer (15.7%) and skin cancers (14.7%) followed by cancers in the lymph nodes (includes primary and secondary; 9.9%.) In women, breast cancer (38.3%) followed by skin cancer skin (9.7%) and uterine cancer (8.7%) was the most common. The overall proportion of cancer diagnoses were breast cancer (20.2%), skin cancer (12.1%), cancer affecting lymph nodes (8.8%), and urinary bladder (8.3%) and colorectal cancer (7.3%). Discussion This preliminary analysis is the first report of cancer types and demographics in areas outside of government control in Syria since the onset of the conflict. Despite limitations, it presents some indication of the burden of oncological diagnoses in this area. Further research which aims to describe and address the burden of cancer on populations under ongoing conflict and humanitarian crises remains essential, especially in Northwest Syria given ongoing attacks and severe underfunding. There is a particular need to investigate how best to apply interventions and support health systems and cancer services within conflict settings. More support and resources need to be allocated to cancer centers with long-term health partnership models. The underresourced and understaffed conditions of the hospital are significant limits to a more detailed report.

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Section: Discussionmentioning

confidence: 99%

Cancer Diagnoses during Active Conflict: Experience from a Cancer Program in Northwest Syria

Atassi¹,

Tse

Mkhallalati

et al. 2022

Avicenna J Med

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“…Studies exclusively studying the Syrian populations in Turkey reported that the majority of Syrian refugees present with breast cancer and advanced stages. On the other hand, Jordanian reports showed a dominance of localized breast cancer cases among Syrian refugees (10,42,43). The UNHCR demonstrated that, in general, refugees in formal camps have very poor survival outcomes even when diagnosed early with cancer.…”

Section: Figurementioning

confidence: 99%

“…In addition, they are more likely to present with advanced stages and suffer more complications because of poor hygiene and living conditions, as well as limited access to care and resources available (8). For refugees, host countries encounter serious challenges in health provision to cancer patients considering the economic pressures they face and the lack of infrastructure, all of which lead to suboptimal care delivery to this subset of patients (9,10). Furthermore, the course of treating many types of cancer requires a robust healthcare system with the ability to provide effective screening programs, diagnostic services, and treatment modalities (e.g., surgery, radiotherapy, or chemotherapy) (11).…”

Section: Introductionmentioning

confidence: 99%

Investigating the impact of COVID-19 on patients with cancer from areas of conflict within the MENA region treated at King Hussein Cancer Center

et al. 2023

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BackgroundThere is a paucity of evidence regarding the impact of COVID-19 on cancer care among refugees or patients from areas of conflict. Cancer care for these populations remains fragmented due to resource scarcity and limited infrastructure.AimsTo explore the effect of COVID-19 on cancer care among patients from areas of conflict treated at King Hussein Cancer Center (KHCC).MethodologyWe performed a retrospective chart review of all patients from areas of conflict, treated at KHCC from 2018 to 2021. Patients’ demographics and clinical characteristics are presented in the form of descriptive statistics. Interrupted Time Series (ITS) analysis was utilized to investigate the impact of COVID-19 on the number of admissions throughout the study’s period.ResultsA total of 3317 patients from areas of conflict were included in the study. Among these, 1546 were males (46.6%) while 1771 (53.4%) were female. Libyans (34.6%), Palestinians (24.8%), Iraqis (24.5%), Syrians (15.3%), and Sudanese patients (0.9%) constituted our study sample. ITS analysis demonstrated that the start of the COVID-19 lockdown significantly decreased admissions by 44.0% (p = 0.020), while the end of the COVID-19 restriction significantly improved admissions by 43.0% (p = 0.023). Among those with available SEER stages, more than a quarter of patients had distant metastasis (n = 935, 28.2%) irrespective of age and biological sex. Advanced presentations during 2020 had approximately a 16% and 6% increase compared to 2018 and 2019, respectively. Breast cancer (21.4%), hematolymphoid cancers (18.1%), and cancers of the digestive system (16.5%) were the most common cancers among our cohort.ConclusionRestrictions associated with COVID-19 had a significant effect on the number of admissions of patients from areas of conflict. In the long term, this effect may impact the survival outcomes of affected patients.

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“…A significant portion of Syrian refugees who reside within host communities in Jordan have access to public health services, including breast cancer screening. Healthcare costs for Syrian refugees are comparable to those of uninsured Jordanians [ 12 ]. On the other hand, refugees living in camps have free access to healthcare services provided by the Jordanian government and international refugee assistance agencies, which tend to be in most cases suboptimal [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Breast Cancer Beliefs and Screening Practices among Syrian Refugee Women and Jordanian Women

Atrooz

Aljararwah

Acquati

et al. 2023

IJERPH

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Despite significant declines in breast cancer (BC) incidence in the West, this disease is widespread in Jordan, where cancer detection occurs at much advanced stages. This is particularly concerning for Syrian refugee women resettled in Jordan, who are less likely to undergo cancer preventative procedures because of poor health literacy and lack of health services access. The present work assesses and compares breast cancer awareness and breast cancer screening behaviors among Syrian refugee women and Jordanian women residing close to the Syrian–Jordanian border city of Ar-Ramtha. A cross-sectional survey was conducted using a validated Arabic version of the Breast Cancer Screening Beliefs Questionnaire (BCSBQ). A total of 138 Syrian refugee women and 160 Jordanian women participated in the study. Results indicate that 93.6% of Syrian refugee women and Jordanian women ≥ 40 years of age reported never having undergone a mammogram. Syrian refugee women and Jordanian women reported low attitudes toward general health checkup (mean score for Syrian refugees 45.6 vs. 42.04 among Jordan women; p = 0.150). Barriers for BC screening were higher among Syrian refugees (mean score = 56.43) than Jordanian women (mean score = 61.99, p = 0.006). Women with higher education were more likely to report fewer barriers to screening (p = 0.027). The study documents a significant lack of BC screening awareness among Syrian refugee women and Jordanian women, indicating that future work is needed to alter current attitudes towards mammograms and early detection measures especially for Syrian refugee women and Jordanian women residing in rural areas of Jordan.

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Late presentation and suboptimal treatment of breast cancer among Syrian refugees: a retrospective study

Cited by 17 publications

References 13 publications

Cancer Diagnoses during Active Conflict: Experience from a Cancer Program in Northwest Syria

Cancer Diagnoses during Active Conflict: Experience from a Cancer Program in Northwest Syria

Investigating the impact of COVID-19 on patients with cancer from areas of conflict within the MENA region treated at King Hussein Cancer Center

Breast Cancer Beliefs and Screening Practices among Syrian Refugee Women and Jordanian Women

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