Disparities in pediatric oncology outcomes in the occupied Palestinian territories: A retrospective study from Augusta Victoria Hospital.

Abstract

1509 Background: Childhood cancer survival rates exceed 80% in high-income countries, but over 80% of the global burden occurs in low- and middle-income countries, where survival rates are significantly lower. The occupied Palestinian territories (OPT)—comprising the West Bank, Gaza, and East Jerusalem—face additional and location-specific challenges, including political instability, movement restrictions, and fragmented healthcare, that would be expected to further negatively impact care. The aim of our study is to report on outcomes of children treated at the only specialized pediatric oncology cancer center, Augusta Victoria Hospital (AVH), located in East Jerusalem. Methods: This was a retrospective IRB approved study conducted by Dana-Farber Cancer Institute and AVH. Chart review was performed to obtain diagnoses, treatments and outcomes of all pediatric oncology patients with histologically confirmed cancer admitted at AVH from January 2018 to June 2024. Results: A total of 424 patients were included, with a median age at diagnosis of 6.95 years (IQR, 3.35–11.2). Of these, 51.2% were male. Patients resided in the West Bank (51.2%), Gaza (43.4%), and East Jerusalem (3.8%). The median diagnostic delay, defined as date of symptom onset to date of diagnosis, was 24.5 days (IQR, 10-45), with significant variation by gender (males: 30 days; females: 20 days, p = 0.018), age group (<5 years: 14 days; ≥5 years: 30 days, p = 0.003), and oncology diagnosis (leukemia: 14 days, lymphoma and solid tumors: 30 days, p = 0.014). Treatment delays, defined as the time form diagnosis to treatment initiation, was 14 days (IQR, 4-30), with the shortest duration for leukemia (2 days) and the longest for solid tumors (30 days, p = 0.008). There were no significant differences in time to treatment by region. The majority of patients lost to follow-up were living in Gaza (15/21, 71%). Among the 13% deaths, 15.4% were treatment-related, primarily due to infection, and most of these treatment-related deaths (65%) occurred in patients living in Gaza. The 3-year overall survival (OS) rate was 76.31%, and event-free survival (EFS) rate was 62.36%. Gaza patients had the lowest 3-year EFS rate (37.12%) compared to the West Bank (70.37%) and East Jerusalem (77.78%; p < 0.0001). Conclusions: This study is the first to report on outcomes of pediatric oncology patients treated at the only specialized center in the OPT. Males and patients older than 5 years experienced longer diagnostic delays, while patients with solid tumors faced treatment delays 15 times longer than those with leukemia. Gaza patients had higher lost to follow-up rates and treatment-related deaths with significantly inferior EFS.