Impact of symptom burden, psychological distress, and treatment accessibility on quality of life in people with cancer in Syria.

Abstract

11046 Background: In low-resource and conflict-affected settings, barriers to cancer care may amplify symptom burden and psychological distress, leading to poor quality of life (QoL). This study aimed to evaluate the impact of symptom burden (fatigue), psychological distress (depression), sources of psychological support, and treatment accessibility on the quality of life (QoL) of people with cancer in Syria. Methods: A cross-sectional study was conducted between April and May 2025 at Albairwni Hospital, Syria’national cancer center. Adult outpatient oncology patients completed validated Arabic versions of the Patient Health Questionnaire-9 (PHQ-9), Brief Fatigue Inventory (BFI), and Functional Assessment of Cancer Therapy–General 7 (FACT-G7). Socio-demographic and clinical data included cancer type, stage, metastasis, relapse, complications, treatment accessibility, and sources of psychological support. Statistical analyses included group comparisons and Spearman correlation. Results: Among 225 participants (median age 53; 71.6% female; 65.8% rural). 41.8% reported difficult access to treatment, while only 18.7% reported easy access. Psychosocial support was primarily provided by family (87.1%), followed by religious sources (37.3%) and healthcare providers (18.2%). Breast cancer comprised 49.3% of cases. By PHQ-9, 77.3% had depressive symptoms (mild 26.7%, moderate 25.8%, moderately severe 17.8%, severe 7.1%). Mean BFI total score was 32.5 ± 23.6. Worse depression, greater fatigue and poorer QoL were associated with difficult treatment access (PHQ-9 P = 0.01; BFI P = 0.01; FACT-G7 P = 0.005), advanced stage (PHQ-9 & FACT-G7 P<0.001; BFI P=0.001), presence of metastases (PHQ-9 P = 0.001; BFI P = 0.01; FACT-G7 P < 0.001). Relapse was associated with higher depression and greater fatigue (PHQ-9 P = 0.04; BFI P = 0.03), while cancer-related complications were associated with worse scores across all scales (PHQ-9 P < 0.001; BFI P = 0.001; FACT-G7 P < 0.001). Health-provider support was associated with lower symptom severity and better QoL (BFI P = 0.01; FACT-G7 P = 0.003). Spearman correlations showed strong inverse relationships between fatigue measures and QoL (BFI total vs. FACT-G7 ρ = −0.71, P < 0.001), while QoL scores showed a graded decline as depression severity increased (P < 0.001). Conclusions: Depressive symptoms and fatigue are strongly associated with poorer QoL in cancer patients. Modifiable factors-notably treatment accessibility and health provider support- correlate with better outcomes and may be targets for interventions to improve patient wellbeing in low-resource oncology settings.