Assessing barriers to cancer care in a war zone: A study of challenges facing patients with GI cancers in Syria.

Abstract

809 Background: Barriers to necessary care can pose a significant burden on patients with cancer, even more so in places of conflict. Following a devastating 14-year war in Syria, there is limited data published on access to cancer care and the impact that barriers to management have on our patients. We surveyed patients presenting for cancer care to better understand the challenges they faced. Methods: This cross-sectional study included adult patients with a confirmed gastrointestinal (GI) cancer diagnosis presenting to Al-Bairouni University Hospital for care. Data was collected through face-to-face interviews using a structured questionnaire adapted for the Syrian context. The survey covered six key areas: Demographic & Clinical, Healthcare System Barriers, Financial Barriers, Geographic & Security Barriers, Reasons for Diagnostic Delays, and Psychosocial Impact. Multivariate analysis via logistic regression was conducted to determine which responses were associated with a higher odds ratio (OR) of having a late-stage (III/IV) cancer diagnosis. Results: A total of 122 patients diagnosed with a GI cancer were enrolled. The mean age was 57.4 years (±11.2 SD), with a male predominance (68%, n=83). Advanced diagnostics (CT/MRI/biopsy) and radiation therapy were inaccessible for 55% (n =67) and 61% (n =74) of patients, respectively. Systemic therapy drugs were "rarely" or "never" available for 35% (n=43) of patients, and 12% (n=15) reported waiting over three months for an appointment. The costs of medications "greatly" or "very greatly" impacted 88% (n=107) of patients. Over two-thirds of patients reported that essential pain control medications (e.g., morphine) were "rarely" or "never" available (68%, n=83). Nearly two-thirds (65%, n =79) reported that security concerns "greatly" or "somewhat" affected their ability to access treatment. An overwhelming 87% (n=106) of patients reported a negative psychological impact from their treatment course. Patient responses associated with a higher OR of late-stage cancer diagnosis are present in the table. Conclusions: Patients in Syria with GI cancers face profound systemic, financial, geographic, and psychosocial challenges throughout their care journey. More than half were diagnosed at advanced stages, with diagnostic delays strongly linked to prolonged waiting times and financial strain. Financial toxicity was highly evident, resulting in treatment compromise and asset liquidation. This data should serve as a reference for future public health and humanitarian efforts in the region. Factors associated with late-stage (III/IV) diagnosis of GI malignancies (multivariate logistic regression). Variable Adjusted Odds Ratio (aOR) 95% Confidence Interval p-value Waiting Time First Oncology appointment >1 month 3.10 1.45 - 6.62 0.003 * Unemployed due to cancer 2.85 1.20 - 6.78 0.018 * Sold Assets to Finance Care 2.40 1.10 - 5.25 0.028 * *Statistically significant at p < 0.05.