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Siddiqui AK, Belgaumi AF. Paediatric oncology in the Eastern Mediterranean region (EMR): the current state and challenges. Ecancermedicalscience 2024; 18:1677. [PMID: 38439809 PMCID: PMC10911667 DOI: 10.3332/ecancer.2024.1677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Indexed: 03/06/2024] Open
Abstract
The WHO Eastern Mediterranean region (EMR) is characterised by highly economically diverse countries, with healthcare systems in various phases of development. Childhood cancer care provision also ranges from that provided in centres able to deliver sophisticated therapy resulting in outcomes comparable to those seen in highly developed nations, to countries with no provision for care of children with cancer. At 10·1 per 100,000 children at risk, the age standardised incidence-rate for cancer in children below 14 years of age is relatively low but may be consequent to poor registration. Shortages in trained care providers were identified in many regional countries, particularly in low and lower-middle income countries, however, implementation of training programs are beginning to counter this deficit. Significant diversity in patient care capacity exists in the region, leading to inequitable access to quality paediatric oncology care. There is strong potential for regional collaboration towards infrastructure and capacity improvement, with facilities available within the EMR for twinning and educational support to those centres and countries that need them. While cancer care coverage is available to citizens of high-income countries, in the lower-income countries out-of-pocket health expenditure can reach 75%. Some relief is achieved through the contribution of multiple charitable foundations working to support childhood cancer care in the region, as well as the provision of care in, often overburdened, public sector hospitals. War and other geo-political turmoil, as well as natural disasters, have negatively impacted healthcare capacity, including childhood cancer care, in several regional countries. Despite all this, the trajectory for change is upward and initiatives such as the WHO Global Initiative for Childhood Cancer are igniting positive change.
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Affiliation(s)
- Arsalan Kabir Siddiqui
- All authors have contributed to this manuscript and take responsibility for its contents
| | - Asim Fakhruddin Belgaumi
- All authors have contributed to this manuscript and take responsibility for its contents
- https://orcid.org/0000-0002-0135-7509
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Erashdi M, Al-Ani A, Mansour A, Al-Hussaini M. Libyan cancer patients at King Hussein Cancer Center for more than a decade, the current situation, and a future vision. Front Oncol 2023; 12:1025757. [PMID: 36776359 PMCID: PMC9911041 DOI: 10.3389/fonc.2022.1025757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 12/15/2022] [Indexed: 01/28/2023] Open
Abstract
Background Since 2011, the Libyan civil war crisis had affected all dimensions of livelihood including cancer care. This has resulted in a steady incline in the number of Libyan patients with cancer seeking oncologic care and management in Tunisia, Egypt and Jordan, among others. King Hussein Cancer Center (KHCC) has been one of the main destinations for Libyan patients with cancer for more than a decade. Aim We are reporting on the characteristics of Libyan patients with cancer presenting to KHCC during the past fourteen years. Methods We performed a retrospective chart review of all Libyan patients with cancer presenting to KHCC between 2006 and 2019. Results A total of 3170 records were included in the final analysis. The overall sample was predominantly adults (71%) with a male-to-female ratio of 1:1.2. Overall, the most common referred cancers to KHCC were breast (21%), hematolymphoid (HL) (17%), and gastrointestinal tract (GIT) (16.2%) cancers. Breast cancer was the most common among adult females (41.7%), GIT among adult males (23.6%), and HL among pediatrics (38.5%). Around 37.8% of patients presented with distant metastasis at their first encounter at KHCC, among which 14.7% were candidates for palliative care. Conclusion The sustenance of treatment for Libyan patients with cancer requires extensive collaboration between governmental and private sectors. The Libyan oncological landscape could benefit from national screening and awareness programs, twining programs and telemedicine, introduction of multidisciplinary boards, and the formulation of a national cancer registry. Adopting the successful models at KHCC can help to augment the oncology services within the Libyan healthcare sector.
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Affiliation(s)
- Madiha Erashdi
- Department of Pathology, James Cook University Hospital, South Tees National Health Service (NHS) Foundation Trust, Middlesbrough, United Kingdom
| | - Abdallah Al-Ani
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan
| | - Asem Mansour
- Human Research Participants Protection Office, King Hussein Cancer Center, Amman, Jordan
| | - Maysa Al-Hussaini
- Human Research Participants Protection Office, King Hussein Cancer Center, Amman, Jordan,*Correspondence: Maysa Al-Hussaini,
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Rihani R, Jeha S, Nababteh M, Rodriguez-Galindo C, Mansour A, Sultan I. The burden and scope of childhood cancer in displaced patients in Jordan: The King Hussein Cancer Center and Foundation Experience. Front Oncol 2023; 13:1112788. [PMID: 37035175 PMCID: PMC10080160 DOI: 10.3389/fonc.2023.1112788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/14/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction Jordan hosts one of the highest numbers of refugees per capita in the world, with the Syrian crisis leading to an influx of displaced persons to the already vulnerable population. However, limited resources and a lack of cancer-care strategies have made it difficult for refugees in Jordan to access quality cancer care. The King Hussein Cancer Center (KHCC) and Foundation (KHCF) have played a pivotal role in providing financial and medical support for displaced children with cancer, treating 968 non-Jordanian children with cancer between 2011-2022, with a median age of 6 years. Of these, 84% were fully funded by KHCF, and nationalities included Syrians (29%), Palestinians (26%), Iraqis (23%), and Yemenis (17%). Cancer diagnoses included solid tumors (44%), leukemia (23%), lymphoma (13%), bone sarcomas (9.5%), and retinoblastoma (9.1%). The median cost of treatment was JOD 18,000 (USD 25,352), with a total estimated cost of JOD 23.8 million (USD 33.5 million). More recently, in partnership with St. Jude Children's Research Hospital (SJCRH), two successive humanitarian funds (HF) were established to optimize cancer care for displaced children in Jordan. Results Between February 2018 and September 2022, 51 children were fully treated on KHCC-SJCRH-HF, with a median age of 6 years and nationalities including Syrians (80%), Iraqis (6%), and Yemenis (8%). The most common cancer diagnoses were leukemia (41%), lymphoma (25%), solid tumors (24%), retinoblastoma (6%), and brain tumors (4%). Of these, 94% are alive and 51% are still receiving coverage. The median coverage for patients was JOD 21,808 (USD 30,715), and the total cost of treatment on KHCC/KHCF-SJCRH/American Lebanese Syrian-Associated Charities HF1 and HF2 was JOD 1.44 million (USD 1.97 million) and JOD 1.18 million (USD 1.67 million), respectively. Conclusion This experience highlights the high burden of displaced children with cancer in Jordan, and the importance of local foundations like KHCC/KHCF and partnerships with international partners like SJCRH in providing lifesaving humanitarian initiatives and quality cancer care. Innovative cancer-care delivery models and sustainable financing are essential to ensure continuous coverage and access to cancer care for displaced persons in Jordan.
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Affiliation(s)
- Rawad Rihani
- Department of Pediatrics, King Hussein Cancer Center, Amman, Jordan
- *Correspondence: Rawad Rihani,
| | - Sima Jeha
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Mayse Nababteh
- International Fundraising and Development Department, King Hussein Cancer Foundation, Amman, Jordan
| | - Carlos Rodriguez-Galindo
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Asem Mansour
- Department of Pediatrics, King Hussein Cancer Center, Amman, Jordan
| | - Iyad Sultan
- Department of Pediatrics, King Hussein Cancer Center, Amman, Jordan
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A systematic review of effective strategies for chronic disease management in humanitarian settings; opportunities and challenges. Prev Med 2022; 161:107154. [PMID: 35817161 DOI: 10.1016/j.ypmed.2022.107154] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/29/2022] [Accepted: 07/05/2022] [Indexed: 11/22/2022]
Abstract
Large number of people with non-communicable diseases (NCDs) face barriers to adequate healthcare in humanitarian settings. We conducted a systematic literature review in MEDLINE/PubMed, Web of Science, EMBASE/DARE, Cochrane, and grey literature from 1990 to 2021 to evaluate effective strategies in addressing NCDs (diabetes, cardiovascular diseases, COPD, cancer) in humanitarian settings. From 2793 articles, 2652 were eliminated through title/abstract screening; 141 articles were reviewed in full; 93 were eliminated for not meeting full criteria. Remaining 48 articles were reviewed qualitatively to assess populations, settings, interventions, outcome, and efficacy and effectiveness; 38 studies addressed treatments, 9 prevention, and 7 epidemiology. Prevention studies broadly addressed capacity-building. Treatment and epidemiology studies largely addressed hypertension and diabetes. Interventions included web-based/mobile health strategies, pharmacy-level interventions, portable imaging, and capacity building including physical clinics, staff training, forging collaborations, guideline development, point-of-care labs, health promotion activities, EMR, and monitoring interventions. Collaboration between academia and implementing agencies was limited. Models of care were largely not well-described and varied between studies due to contextual constraints. Barriers to interventions included financial, logistical, organizational, sociocultural, and security. Cancer care is significantly understudied. Simplified care models adapted to contexts and program evaluations of implemented strategies could address gaps in applied research. Inherent challenges in humanitarian settings pose unavoidable perils to evidence generation which requires a shift in research mindset to match aspirations with practicality, research collaborations at the inception of projects, reworking of desired conventional level of research evidence considering resource-intense constraints (HR, time, cost), and adapted research tools, methods, and procedures.
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Baatz RK, Ekzayez A, Meagher K, Bowsher G, Patel P. Cross-border strategies for access to healthcare in violent conflict – a scoping review. J Migr Health 2022; 5:100093. [PMID: 35373166 PMCID: PMC8971640 DOI: 10.1016/j.jmh.2022.100093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/17/2022] [Accepted: 03/17/2022] [Indexed: 11/30/2022] Open
Abstract
Background The geographical reconfiguration of healthcare systems in times of violent conflict is increasingly being recognised in academic literature. This includes conflict-induced, cross-border travel for medical treatment. Yet the conceptual approach to this healthcare-seeking behaviour, by a population here referred to as cross-border population, remains poorly understood. This scoping review identifies academic literature on cross-border populations to map the current approach to cross-border populations and to propose a research agenda. Methods The study used a scoping review following the Joanna Briggs Institute Scoping Review methodology. We included articles on conflicts between 1980 and 2019. Results A total of 53 articles met the inclusion criteria. From these articles, we distinguished four types of studies on cross-border healthcare: Direct analysis, implicit analysis, clinical research, and identification. The 45 articles belonging to the first three categories were then searched for themes specifically relevant to healthcare for cross-border populations and linked with sub-themes such as border crossing time and the types of healthcare available. These themes were structured into three main areas: access to care; quality of care; and governance of care. Our analysis then describes the available knowledge, documented practices, and challenges of cross-border healthcare specifically in conflict settings. Conclusions A better understanding of cross-border healthcare systems is required to inform local practices and develop related regional and international policies. While the reviewed literature provides some highlights on various practices of cross-border healthcare, there are many gaps in available knowledge of this topic. To address these gaps, our study proposes a research framework outlining key themes and research questions to be investigated by signposting where major research and operational gaps remain. This facilitates well-directed future work on cross-border therapeutic geographies in the context of armed conflict and furthers understanding of a hitherto largely ignored area of the international healthcare system.
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Shah S, Munyuzangabo M, Gaffey MF, Kamali M, Jain RP, Als D, Meteke S, Radhakrishnan A, Siddiqui FJ, Ataullahjan A, Bhutta ZA. Delivering non-communicable disease interventions to women and children in conflict settings: a systematic review. BMJ Glob Health 2021; 5:bmjgh-2019-002047. [PMID: 32341086 PMCID: PMC7202786 DOI: 10.1136/bmjgh-2019-002047] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 03/30/2020] [Accepted: 04/04/2020] [Indexed: 12/25/2022] Open
Abstract
Background Non-communicable diseases (NCDs) are the leading cause of death worldwide. In the context of conflict settings, population displacement, disrupted treatment, infrastructure damage and other factors impose serious NCD intervention delivery challenges, but relatively little attention has been paid to addressing these challenges. Here we synthesise the available indexed and grey literature reporting on the delivery of NCD interventions to conflict-affected women and children in low- and middle-income countries (LMICs). Methods A systematic search in MEDLINE, Embase, CINAHL and PsycINFO databases for indexed articles published between 1 January 1990 and 31 March 2018 was conducted, and publications reporting on NCD intervention delivery to conflict-affected women or children in LMICs were included. A grey literature search of 10 major humanitarian organisation websites for publications dated between 1 January 2013 and 30 November 2018 was also conducted. We extracted and synthesised information on intervention delivery characteristics and delivery barriers and facilitators. Results Of 27 included publications, most reported on observational research studies, half reported on studies in the Middle East and North Africa region and 80% reported on interventions targeted to refugees. Screening and medication for cardiovascular disease and diabetes were the most commonly reported interventions, with most publications reporting facility-based delivery and very few reporting outreach or community approaches. Doctors were the most frequently reported delivery personnel. No publications reported on intervention coverage or on the effectiveness of interventions among women or children. Limited population access and logistical constraints were key delivery barriers reported, while innovative technology use, training of workforce and multidisciplinary care were reported to have facilitated NCD intervention delivery. Conclusion Large and persistent gaps in information and evidence make it difficult to recommend effective strategies for improving the reach of quality NCD care among conflict-affected women and children. More rigorous research and reporting on effective strategies for delivering NCD care in conflict contexts is urgently needed. PROSPERO registration number CRD42019125221
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Affiliation(s)
- Shailja Shah
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mariella Munyuzangabo
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michelle F Gaffey
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mahdis Kamali
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Reena P Jain
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Daina Als
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sarah Meteke
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Amruta Radhakrishnan
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Fahad J Siddiqui
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada.,Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore
| | - Anushka Ataullahjan
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada .,Center of Excellence in Women and Children Health, Aga Khan University, Karachi, Pakistan
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Alawa J, Hamade O, Alayleh A, Fayad L, Khoshnood K. Cancer Awareness and Barriers to Medical Treatment Among Syrian Refugees and Lebanese Citizens in Lebanon. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:709-717. [PMID: 30924080 DOI: 10.1007/s13187-019-01516-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The Syrian conflict has forced over a million refugees into Lebanon, which now faces the challenge of providing healthcare for this large, vulnerable population. Syrian refugees and Lebanese citizens suffer from an immense burden of cancer and encounter many barriers to obtaining healthcare. An increase in cancer awareness could prompt earlier diagnosis and treatment. This study aims to evaluate the level of cancer awareness and barriers to medical treatment among Syrian refugees and Lebanese citizens in Lebanon. A descriptive cross-sectional survey design was used. Four hundred seventeen Syrian refugees and 319 Lebanese citizens seeking healthcare in Lebanon completed the Cancer Awareness Measure. The mean age of Syrian refugees and Lebanese citizens was 33.8 years (SD 11.9) and 41.7 years (SD 16.3), respectively. Syrian refugees and Lebanese citizens were only able to recognize a low number of cancer symptoms (mean 4.2 (out of 9), SD 2.4 and 3.9, SD 2.3, respectively) and risk factors (mean 5.1 (out of 11), SD 2.6 and 5.2, SD 2.9, respectively). Barriers to seeking medical care were prevalent. The most commonly reported barrier among both samples was having no medical insurance or funds to cover the cost of treatment (78.9% and 67.7%, respectively). A comprehensive restructuring of the Lebanese healthcare system and a massive influx of resources are required for Syrian refugees and Lebanese citizens to obtain adequate access to cancer treatment. To encourage early diagnosis and treatment, much more work is needed to overcome barriers and enhance knowledge of cancer.
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Affiliation(s)
| | - Omar Hamade
- Santa Clara University, Santa Clara, CA, USA
| | - Amin Alayleh
- University of California San Diego, San Diego, CA, USA
| | - Luna Fayad
- University of Miami, Coral Gables, FL, USA
| | - Kaveh Khoshnood
- Yale School of Public Health, 60 College Street, Ste 405, New Haven, CT, 06510, USA.
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Spiegel PB, Cheaib JG, Aziz SA, Abrahim O, Woodman M, Khalifa A, Jang M, Mateen FJ. Cancer in Syrian refugees in Jordan and Lebanon between 2015 and 2017. Lancet Oncol 2020; 21:e280-e291. [PMID: 32359503 DOI: 10.1016/s1470-2045(20)30160-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/04/2020] [Accepted: 03/04/2020] [Indexed: 01/19/2023]
Abstract
Protracted conflicts in the Middle East have led to successive waves of refugees crossing borders. Chronic, non-communicable diseases are now recognised as diseases that need to be addressed in such crises. Cancer, in particular, with its costly, multidisciplinary care, poses considerable financial and ethical challenges for policy makers. In 2014 and with funding from the United Nations High Commissioner for Refugees, we reported on cancer cases among Iraqi refugees in Jordan (2010-12) and Syria (2009-11). In this Policy Review, we provide data on 733 refugees referred to the United Nations High Commissioner for Refugees in Lebanon (2015-17) and Jordan (2016-17), analysed by cancer type, demographic risk factors, treatment coverage status, and cost. Results show the need for increased funding and evidence-based standard operating procedures across countries to ensure that patients have equitable access to care. We recommend a holistic response to humanitarian crises that includes education, screening, treatment, and palliative care for refugees and nationals and prioritises breast cancer and childhood cancers.
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Affiliation(s)
- Paul B Spiegel
- Department of International Health, Johns Hopkins University, Baltimore, MD, USA; Center for Humanitarian Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Joseph G Cheaib
- Department of International Health, Johns Hopkins University, Baltimore, MD, USA
| | - Saad Abdel Aziz
- Department of International Health, Johns Hopkins University, Baltimore, MD, USA
| | - Orit Abrahim
- Center for Humanitarian Health, Johns Hopkins University, Baltimore, MD, USA
| | - Michael Woodman
- Office of the United Nations High Commissioner for Refugees, Beirut, Lebanon
| | - Adam Khalifa
- Office of the United Nations High Commissioner for Refugees, Damascus, Syria
| | - Minyoung Jang
- Johns Hopkins Bloomberg School of Public Health, and Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Farrah J Mateen
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA
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Conflict-driven social change: the case of Syrian children and youth. Curr Opin Psychol 2020; 35:114-118. [PMID: 32652506 DOI: 10.1016/j.copsyc.2020.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/29/2020] [Accepted: 06/01/2020] [Indexed: 12/25/2022]
Abstract
For Syrian children, the civil war which emerged as a consequence of the Arab Spring has driven massive social change both at the structural level of legal, socioeconomic, educational and health systems, and at the intimate heart of everyday family life. This paper reviews recent research to understand the nature and impact of conflict-driven social change on children's lives. Research from the region and Western resettlement contexts indicates that Syrian refugee children have experienced high levels of exposure to conflict-related traumatic events and elevated rates of mental health difficulties, with evidence to suggest that adolescent girls in the region exhibit poorer well-being than boys. The research captures the social destruction experienced by children and families, and the adaptations forced by survival and protection needs to pre-conflict age, gender and family role norms.
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Abdul-Khalek RA, Guo P, Sharp F, Gheorghe A, Shamieh O, Kutluk T, Fouad F, Coutts A, Aggarwal A, Mukherji D, Abu-Sittah G, Chalkidou K, Sullivan R. The economic burden of cancer care for Syrian refugees: a population-based modelling study. Lancet Oncol 2020; 21:637-644. [PMID: 32359488 DOI: 10.1016/s1470-2045(20)30067-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/21/2020] [Accepted: 01/24/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Cancer represents a substantial health burden for refugees and host countries. However, no reliable data on the costs of cancer care for refugees are available, which limits the planning of official development assistance in humanitarian settings. We aimed to model the direct costs of cancer care among Syrian refugee populations residing in Jordan, Lebanon, and Turkey. METHODS In this population-based modelling study, direct cost per capita and per incident case for cancer care were estimated using generalised linear models, informed by a representative dataset of cancer costs drawn from 27 EU countries. A range of regression specifications were tested, in which cancer costs were modelled using different independent variables: gross domestic product (GDP) per capita, crude or age-standardised incidence, crude or age-standardised mortality, and total host country population size. Models were compared using the Akaike information criterion. Total cancer care costs for Syrian refugees in Jordan, Lebanon, and Turkey were calculated by multiplying the estimated direct cancer care costs (per capita) by the total number of Syrian refugees, or by multiplying the estimated direct cancer costs (per incident case [crude or age-standardised]) by the number of incident cancer cases in Syrian refugee populations. All costs are expressed in 2017 euros (€). FINDINGS Total cancer care costs for all 4·74 million Syrian refugees in Jordan, Lebanon, and Turkey in 2017 were estimated to be €140·23 million using the cost per capita approach, €79·02 million using the age-standardised incidence approach, and €33·68 million using the crude incidence approach. Under the lowest estimation, and with GDP and total country population as model predictors, the financial burden of cancer care was highest for Turkey (€25·18 million), followed by Lebanon (€6·40 million), and then Jordan (€2·09 million). INTERPRETATION Cancer among the Syrian refugee population represents a substantial financial burden for host countries and humanitarian agencies, such as the UN Refugee Agency. New ways to provide financial assistance need to be found and must be coupled with clear, prioritised pathways and models of care for refugees with cancer. FUNDING UK Research and Innovation Global Challenges Research Fund: Research for Health in Conflict-Middle East and North Africa region (R4HC-MENA).
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Affiliation(s)
- Rima A Abdul-Khalek
- Global Health Institute, American University of Beirut, Beirut, Lebanon; Conflict and Health Research Group, School of Security Studies, King's College London, London, UK
| | - Ping Guo
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK; School of Nursing, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Forbes Sharp
- Conflict and Health Research Group, School of Security Studies, King's College London, London, UK; Institute of Cancer Policy, School of Cancer Sciences, King's College London, London, UK
| | - Adrian Gheorghe
- School of Public Health, Department of Infectious Disease Epidemiology and Global Health and Development Group, Imperial College London, London, UK
| | - Omar Shamieh
- Centre for Palliative and Cancer Care in Conflict, King Hussein Cancer Centre, Amman, Jordan
| | - Tezer Kutluk
- Centre for Palliative and Cancer Care in Conflict, Hacettepe University, Ankara, Turkey
| | - Fouad Fouad
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Adam Coutts
- Department of Sociology and Magdalene College, University of Cambridge, Cambridge, UK
| | - Ajay Aggarwal
- Institute of Cancer Policy, School of Cancer Sciences, King's College London, London, UK
| | - Deborah Mukherji
- Global Health Institute, American University of Beirut, Beirut, Lebanon; Conflict and Health Research Group, School of Security Studies, King's College London, London, UK
| | - Ghassan Abu-Sittah
- Global Health Institute, American University of Beirut, Beirut, Lebanon; Conflict and Health Research Group, School of Security Studies, King's College London, London, UK
| | - Kalipso Chalkidou
- School of Public Health, Department of Infectious Disease Epidemiology and Global Health and Development Group, Imperial College London, London, UK; Centre for Global Development, Washington, DC, USA
| | - Richard Sullivan
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK; Institute of Cancer Policy, School of Cancer Sciences, King's College London, London, UK.
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11
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Affiliation(s)
- Dina Mired
- Union for International Cancer Control, Geneva, Switzerland
| | - Sonali Johnson
- Union for International Cancer Control, Geneva, Switzerland
| | - Gevorg Tamamyan
- Yerevan State Medical University, Department of Pediatric Oncology and Hematology, Yerevan, Armenia.
- Pediatric Cancer and Blood Disorders Center of Armenia, Hematology Center after Prof. R.H.Yeolyan, Yerevan, Armenia.
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12
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Gheorghe A, Chalkidou K, Shamieh O, Kutluk T, Fouad F, Sultan I, Sullivan R. Economics of Pediatric Cancer in Four Eastern Mediterranean Countries: A Comparative Assessment. JCO Glob Oncol 2020; 6:1155-1170. [PMID: 32697668 PMCID: PMC7392699 DOI: 10.1200/go.20.00041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2020] [Indexed: 01/14/2023] Open
Abstract
PURPOSE Cancer is a leading cause of death among children in the Eastern Mediterranean region, where conflict and economic downturn place additional burden on the health sector. In this context, using economic evidence to inform policy decisions is crucial for maximizing health outcomes from available resources. We summarized the available evidence on the economics of pediatric cancer in Jordan, Lebanon, the occupied Palestinian territory, and Turkey. METHODS A scoping review was performed of seven academic databases and gray literature pertaining to pediatric cancer in the four jurisdictions, published between January 1, 2010, and July 17, 2019. Information was extracted and organized using an analytical framework that synthesizes economic information on four dimensions: the context of the health system, the economics of health care inputs, the economics of service provision, and the economic consequences of disease. RESULTS Most of the economic evidence available across the four jurisdictions pertains to the availability of health care inputs (ie, drugs, human resources, cancer registration data, and treatment protocols) and individual-level outcomes (either clinical or health-related quality of life). We identified little evidence on the efficiency or quality of health care inputs and of pediatric cancer services. Moreover, we identified no studies examining the cost-effectiveness of any intervention, program, or treatment protocol. Evidence on the economic consequences of pediatric cancer on families and the society at large was predominantly qualitative. CONCLUSION The available economic evidence on pediatric cancer care in the four countries is limited to resource availability and, to an extent, patient outcomes, with a substantial gap in information on drug quality, service provision efficiency, and cost-effectiveness. Links between researchers and policymakers must be strengthened if pediatric cancer spending decisions, and, ultimately, treatment outcomes, are to improve.
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Affiliation(s)
- Adrian Gheorghe
- Global Health and Development, Imperial College London, London, United Kingdom
| | - Kalipso Chalkidou
- Global Health and Development, Imperial College London, London, United Kingdom
- Center for Global Development Europe, London, United Kingdom
| | - Omar Shamieh
- Center for Palliative and Cancer Care in Conflict, Department of Palliative Care, King Hussein Cancer Center, Amman, Jordan
| | - Tezer Kutluk
- Department of Pediatric Oncology, Hacettepe University, Ankara, Turkey
| | - Fouad Fouad
- Faculty of Health Sciences, Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Iyad Sultan
- Department of Pediatric Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Richard Sullivan
- Institute for Cancer Policy and Conflict & Health Research Group, King's College London, London, United Kingdom
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13
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Basbous M, Al-Jadiry M, Belgaumi A, Sultan I, Al-Haddad A, Jeha S, Saab R. Childhood cancer care in the Middle East, North Africa, and West/Central Asia: A snapshot across five countries from the POEM network. Cancer Epidemiol 2020; 71:101727. [PMID: 32499117 DOI: 10.1016/j.canep.2020.101727] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 04/20/2020] [Accepted: 04/22/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The Pediatric Oncology East and Mediterranean (POEM) network, through this report, provides a snapshot view of an expected child's treatment journey in five countries in the region. METHODS Pediatric oncologists from cancer centers in Egypt, Lebanon, Iraq, Jordan, and Pakistan provided input on referral pathways, barriers to care, and patient outcomes, based on personal experience and published data. Outcome data were extracted from institutional registries. A literature review of articles and meeting abstracts was conducted, and results summarized. RESULTS Countries across the Middle Eastern, North African, and West Asian region face common difficulties relating to the provision of pediatric oncology care. National registries are largely lacking, with unavailability of outcome data. Economic barriers are a common theme, leading to delays in patient diagnosis, and interruptions and abandonment of therapy. Insufficient infrastructure and human resources, high rates of toxic deaths, and lack of common national protocols are common. The establishment of successful fundraising organizations linked to specific cancer hospitals showcase several success stories, enhancing services, improving patient access, and leading to outcomes comparable to those in developed countries. All identified published literature is institution-based and from only one or a few hospitals. Therefore, outcomes at a national level likely differ due to disparate cancer care capabilities. CONCLUSION Well-designed national registries are essential for identifying gaps, and clear referral networks are needed to address delays to diagnosis and therapy. National and transversal programs to improve infrastructure, facilitate knowledge transfer, and promote advocacy, are needed to accelerate progress in the region.
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Affiliation(s)
- Maya Basbous
- Children's Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mazin Al-Jadiry
- Department of Pediatrics, College of Medicine-University of Baghdad, Children's Welfare Teaching Hospital-Medical City, Baghdad, Iraq
| | - Asim Belgaumi
- Department of Oncology, Aga Khan University, Karachi, Pakistan
| | - Iyad Sultan
- Pediatric Oncology, King Hussein Cancer Centre, Amman, Jordan
| | - Alaa Al-Haddad
- Pediatric Oncology Department and Pediatric Stem Cell Transplantation Unit, Children's Cancer Hospital Egypt (CCHE 57357), Cairo, Egypt; Pediatric Oncology Department and Hematopoietic Stem Cell Transplantation, National Cancer Institute (NCI), Cairo University, Cairo, Egypt
| | - Sima Jeha
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Raya Saab
- Children's Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon; Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
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14
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McNatt ZZ. Addressing noncommunicable diseases among urban refugees in the Middle East and North Africa - a scoping review. Confl Health 2020; 14:9. [PMID: 32099579 PMCID: PMC7029555 DOI: 10.1186/s13031-020-0255-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 01/29/2020] [Indexed: 12/02/2022] Open
Abstract
Background More than 5.5 million Syrian refugees have fled violence and settled in mostly urban environments in neighboring countries. The Middle East and North Africa (MENA) region accounts for 6% of the global population but 25% of the population are ‘of concern’ to the UN Refugee Agency. In addition to large amounts of forced migration, the region is also undergoing an epidemiologic transition towards a heavier burden of noncommunicable diseases (NCDs), which in 2018 accounted for 74% of all deaths in the region. To address NCD needs globally, a myriad of policies and interventions have been implemented in low-income stable country settings. However, little is known about which policies and interventions are currently being implemented or are best suited for refugee hosting countries across the Middle East and North Africa. Methods A scoping review of peer-reviewed literature was conducted to identify policies and interventions implemented in the Middle East and North Africa to address the needs of urban refugees with noncommunicable diseases. Results This scoping review identified 11 studies from Jordan, Lebanon, Iran, West Bank, Gaza and Syria. These studies addressed three foci of extant work, (1) innovative financing for expensive treatments, (2) improvements to access and quality of treatment and, (3) efforts to prevent new diagnoses and secondary complications. All interventions targeted refugee populations including Palestinians, Sudanese, Syrians, Afghans and Iraqis. Discussion The scoping review highlighted five key findings. First, very few studies focused on the prevention of noncommunicable diseases among displaced populations. Second, several interventions made use of health information technologies, including electronic medical records and mHealth applications for patients. Third, the vast majority of publications were solely focused on tackling NCDs through primary care efforts. Fourth, the literature was very sparse in regard to national policy development, and instead favored interventions by NGOs and UN agencies. Last, the perspectives of refugees were notably absent. Conclusion Opportunities exist to prioritize prevention efforts, scale up eHealth interventions, expand access to secondary and tertiary services, address the scarcity of research on national policy, and incorporate the perspectives of affected persons in the broader discourse.
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Affiliation(s)
- Zahirah Z McNatt
- Department of Community Health and Social Medicine, University of Global Health Equity, Kigali Heights, Plot 772, KG 7 Ave., 5th floor, P.O. Box 6955, Kigali, Rwanda.,2Mailman School of Public Health, Department of Population and Family Health, Columbia University, 60 Haven Avenue B3, New York, 10032 USA
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15
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Bilani N, Jamali S, Chahine A, Zorkot M, Homsi M, Saab M, Saab R, Nabulsi M, Chaaya M. Illness cognition and health anxiety in parents of children with cancer. J Psychosoc Oncol 2019; 37:713-728. [DOI: 10.1080/07347332.2019.1600629] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Nadeem Bilani
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Sarah Jamali
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | | | - Maya Zorkot
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Mouafak Homsi
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Michael Saab
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Raya Saab
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
- Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
- Lebanon Children’s Cancer Center of Lebanon, American University of Beirut, Beirut, Lebanon
| | - Mona Nabulsi
- Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
| | - Monique Chaaya
- Department of Epidemiology and Population Health, American University of Beirut, Beirut, Lebanon
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16
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Armenian SH. Health equity for displaced children with cancer in the Middle East. Cancer 2018; 124:1322-1325. [PMID: 29489014 DOI: 10.1002/cncr.31268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 01/04/2018] [Accepted: 01/05/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Saro H Armenian
- Department of Population Sciences, City of Hope, Duarte, California
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