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Al Daragemeh AI, Saleh AM, Abdel-Aziz HR, Ebrahim EE. Nurses' Insights and Experiences in Palliative Chemotherapy Care. Asian Pac J Cancer Prev 2024; 25:299-303. [PMID: 38285797 PMCID: PMC10911718 DOI: 10.31557/apjcp.2024.25.1.299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 01/25/2024] [Indexed: 01/31/2024] Open
Abstract
OBJECTIVE The study sought to provide an overview of the perspectives and experiences of Jordanian nurses in the context of caring for patients undergoing palliative chemotherapy. METHODS A phenomenological qualitative design was used to explore the perspectives and experiences of 11 Jordanian nurses providing care to patients receiving palliative chemotherapy at a governmental cancer care center. RESULTS The nurses identified two main themes: "Patient Persistence in Hope" and "Positive Impacts of Palliative Chemotherapy." They observed that some patients held onto false hopes of a cure when consenting to palliative chemotherapy, often influenced by family pressure. However, despite acknowledging fatigue as a major side effect, the nurses generally had a positive view of palliative chemotherapy, especially when it improved patients' quality of life or relieved pain. The nurses believed that the patients' resilience and positive attitude during treatment were encouraging. CONCLUSION To better support patients, the study suggests that nurses should gain a deeper understanding of the significance patients attach to hope in advanced cancer situations to avoid misinterpreting it as denial or false optimism.
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Affiliation(s)
| | - Ahmad Mahmoud Saleh
- Department of Nursing, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia.
| | - Hassanat R. Abdel-Aziz
- Department of Nursing, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia.
| | - Elturabi E Ebrahim
- Department of Nursing, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia.
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2
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Jatobá A, Bellas H, Arcuri R, Sobral ALA, Bulhões B, Vianna J, de Castro Nunes P, d'Avila AL, de Carvalho PVR. Decentralizing referral prioritization to general practitioners at the primary care level: A qualitative case study based on the Grounded Theory. Work 2024; 77:1189-1203. [PMID: 37980591 DOI: 10.3233/wor-230228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023] Open
Abstract
BACKGROUND Patient referral prioritizations is an essential process in coordinating healthcare delivery, since it organizes the waiting lists according to priorities and availability of resources. OBJECTIVE This study aims to highlight the consequences of decentralizing ambulatory patient referrals to general practitioners that work as family physicians in primary care clinics. METHODS A qualitative case study was carried out in the municipality of Rio de Janeiro. The ten health regions of Rio de Janeiro were visited during fieldwork, totalizing 35 hours of semi-structured interviews and approximately 70 hours of analysis based on the Grounded Theory. RESULTS The findings of this study show that the obstacles to adequate referrals are beyond the management of vacancies, ranging from the standardization of prioritization criteria to ensuring the proper employment of referral protocols in diverse locations assisted by overloaded health workers with different backgrounds and perceptions. Efforts in decentralizing patient referral to primary care still face the growing dilemmas and challenges of expanding the coverage of health services while putting pressure on risk assessment, as well as sustaining the autonomy of physicians' work while respecting the eligibility when ordering waiting lists. CONCLUSION A major strength of this work is on the method to organize and aggregate qualitative data using visual representations. Limitations concerning the reach of fieldwork in vulnerable and hardly accessible areas were overcame using snowball sampling techniques, making more participants accessible.
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Affiliation(s)
- Alessandro Jatobá
- Centro de Estudos Estratégicos Antônio Ivo de Carvalho (CEE), Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Hugo Bellas
- Centro de Estudos Estratégicos Antônio Ivo de Carvalho (CEE), Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Rodrigo Arcuri
- Programa de Pós-Graduação em Engenharia de Produção (TPP), Universidade Federal Fluminense (UFF), Niterói, Brazil
| | - André Luiz Avelino Sobral
- Programa de Pós-Graduação em Engenharia de Produção (TPP), Universidade Federal Fluminense (UFF), Niterói, Brazil
| | - Bárbara Bulhões
- Centro de Estudos Estratégicos Antônio Ivo de Carvalho (CEE), Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Jaqueline Vianna
- Centro de Estudos Estratégicos Antônio Ivo de Carvalho (CEE), Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Paula de Castro Nunes
- Centro de Estudos Estratégicos Antônio Ivo de Carvalho (CEE), Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - Paulo Victor Rodrigues de Carvalho
- Centro de Estudos Estratégicos Antônio Ivo de Carvalho (CEE), Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
- Instituto de Engenharia Nuclear (IEN), Rio de Janeiro, Brazil
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Lynch KA, Merdjanoff AA. Impact of Disasters on Older Adult Cancer Outcomes: A Scoping Review. JCO Glob Oncol 2023; 9:e2200374. [PMID: 37290025 PMCID: PMC10497294 DOI: 10.1200/go.22.00374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 06/10/2023] Open
Abstract
PURPOSE There is an urgent need to address the growing global cancer burden in the context of complex disaster events, which both disrupt access to oncology care and facilitate carcinogenic exposures. Older adults (65 years and older) are a growing population with multifaceted care needs, making them especially vulnerable to disasters. The objective of this scoping review is to characterize the state of the literature concerning older adult cancer-related outcomes and oncologic care after a disaster event. METHODS A search was conducted in PubMed and Web of Science. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for scoping reviews, articles were extracted and screened for inclusion. Eligible articles were summarized using descriptive and thematic analyses. RESULTS Thirty-five studies met all criteria for full-text review. The majority focused on technological disasters (60%, n = 21), followed by climate-amplified disasters (28.6%, n = 10) and geophysical disasters (11.4%, n = 4). Thematic analysis classified the current evidence into three major categories: (1) studies concerned with carcinogenic exposure and cancer incidence related to the disaster event, (2) studies examining changes in access to cancer care and cancer treatment disruptions as a result of the disaster event, and (3) studies exploring the psychosocial experiences of patients with cancer affected by a disaster event. Few studies focused on older adults specifically, and most of the current evidence focuses on disasters in the United States or Japan. CONCLUSION Older adult cancer outcomes after a disaster event are understudied. Current evidence suggests that disasters worsen cancer-related outcomes among older adults by disrupting continuity of care and access to timely treatment. There is a need for prospective longitudinal studies following older adult populations postdisaster and studies focused on disasters in low- and middle-income country contexts.
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Affiliation(s)
- Kathleen A. Lynch
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY
| | - Alexis A. Merdjanoff
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY
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4
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Yousef YA, Abu Salim QF, Mohammad M, Jaradat I, Mehyar M, AlJabari R, Al-Habahbeh O, Saboubeh K, Halalsheh H, Khzouz J, Shawagfeh M, Sultan I, AlMasri M, Al-Nawaiseh I, Al-Hussaini M, Mansour A. Presentation and management outcomes of Retinoblastoma among Syrian refugees in Jordan. Front Oncol 2023; 12:1056963. [PMID: 36713556 PMCID: PMC9880551 DOI: 10.3389/fonc.2022.1056963] [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: 09/29/2022] [Accepted: 12/20/2022] [Indexed: 01/15/2023] Open
Abstract
Purpose The humanitarian crisis in Syria has had a profound impact on the entire region. In this study, we report the patterns of presentation and management outcomes of Syrian patients with Retinoblastoma (Rb) treated at a single tertiary cancer center in Jordan. Methods and Materials This is a retrospective comparative study of Syrian refugees and Jordanian citizens who had Rb between 2011 and 2020. Collected data included patient demographics, presentation, tumor stage, treatment modalities, eye salvage rate, metastasis, and mortality. Results Thirty Syrian refugees (16 (53%) had bilateral disease) and 124 Jordanian citizens (51(41%) had bilateral disease) were diagnosed with Rb during this period. The median age at diagnosis for refugees was 10 and 32 months for patients with bilateral and unilateral Rb consecutively, compared to 6 and 28 months for citizens. The median lag time between signs of disease and initiation of treatment was 3 months for refugees, compared to 1 month for citizens.Refugees were more likely to present with a more advanced stage (p=0.046). Out of 46 affected eyes in refugees; 32 (70%) eyes were group D or E, while out of 175 affected eyes among citizens; 98 (56%) eyes were group D or E. Therefore, refugees with Rb were more likely to mandate primary enucleation (48%) compared to citizens (25%) (p=0.003). However, out of 24 eyes among refugees who received conservative therapy, 15 (62%) eyes were successfully salvaged, while out of 131 affected eyes among citizens who received conservative therapy, 105 (80%) eyes were successfully salvaged (p=0.06). Two (7%) of the refugees and four (3.2%) of the citizens with Rb died from metastasis. Conclusion Syrian refugees with Rb presented with more advanced disease due to delay in diagnosis and referral that increased the treatment burden by decreasing the chance for eye globe salvage. However, patients who received the timely intervention had a similar outcome to citizens with Rb; probably a reflection of the management of all patients at a single specialized center. We advocate for the timely referral of refugees with this rare life-threatening tumor to a specialized cancer center for the best possible outcome.
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Affiliation(s)
- Yacoub A. Yousef
- Department of Surgery, King Hussein Cancer Centre (KHCC), Amman, Jordan,*Correspondence: Yacoub A. Yousef,
| | | | - Mona Mohammad
- Department of Surgery, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Imad Jaradat
- Department Radiation Oncology, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Mustafa Mehyar
- Department of Surgery, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Reem AlJabari
- Department of Surgery, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Omar Al-Habahbeh
- Department of Surgery, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Khalid Saboubeh
- Department of Surgery, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Hadeel Halalsheh
- Department Pediatrics Oncology, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Jakub Khzouz
- Department Pathology and Laboratory Medicine, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Munir Shawagfeh
- Department Anesthesia, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Iyad Sultan
- Department Pediatrics Oncology, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Mahmoud AlMasri
- Department of Surgery, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | | | - Maysa Al-Hussaini
- Department Pathology and Laboratory Medicine, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Asem Mansour
- Department Diagnostic Radiology, King Hussein Cancer Centre (KHCC), Amman, Jordan
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5
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Al-Hussaini M, Al-Ani A, Hammouri M, Al-Huneidy L, Mansour A. Investigating the impact of COVID-19 on patients with cancer from areas of conflict within the MENA region treated at King Hussein Cancer Center. Front Oncol 2023; 13:1088000. [PMID: 36910625 PMCID: PMC9995942 DOI: 10.3389/fonc.2023.1088000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/30/2023] [Indexed: 02/25/2023] Open
Abstract
Background There 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. Aims To explore the effect of COVID-19 on cancer care among patients from areas of conflict treated at King Hussein Cancer Center (KHCC). Methodology We 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. Results A 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. Conclusion Restrictions 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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Affiliation(s)
- Maysa Al-Hussaini
- Department of Pathology and Laboratory Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Abdallah Al-Ani
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan
| | | | | | - Asem Mansour
- Department of Radiology, King Hussein Cancer Center, Amman, Jordan
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6
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Access to Radiation Therapy by Syrian Refugees Displaced to Turkey. Adv Radiat Oncol 2022; 7:100976. [PMID: 35865370 PMCID: PMC9294976 DOI: 10.1016/j.adro.2022.100976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 04/14/2022] [Indexed: 11/30/2022] Open
Abstract
For over 10 years, the Syrian conflict has caused millions of people to leave their homeland, causing one of the biggest refugee crises in modern history. Considering its prevalence, cancer is an important care burden among Syrian refugees. Radiation therapy is one of the essential parts of cancer treatment, and radiation oncology departments must guarantee optimal cancer treatments even in such a challenging setting when patients are displaced forcefully from their homes. National and institutional measures are highlighted in this manuscript to provide suggestions for the delivery of care during refugee crises. There are two issues creating barriers to serving refugee populations: the loss of access to their original care records in Syria for those with a previous diagnosis of cancer referred for continuation of radiation therapy or reirradiation, and the effect of acute radiation therapy toxicity on treatment compliance.
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Sayan M, Eren MF, Kilic SS, Kotek A, Kaplan SO, Duran O, Cukurcayır F, Babalıoglu I, Or OD, Ozturk GA, Eroglu C, Teke F, Kurtul N, Kutuk T, Bicakci BC, Senyurek S, Aktan M, Mamidanna S, Ohri N, Haffty B, Atalar B. Utilization of radiation therapy and predictors of noncompliance among Syrian refugees in Turkey. BMC Cancer 2022; 22:532. [PMID: 35550042 PMCID: PMC9097407 DOI: 10.1186/s12885-022-09558-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 04/17/2022] [Indexed: 11/26/2022] Open
Abstract
Background Access to cancer care is a problem that continues to plague refugees displaced from their home countries. The turbulent political crisis in Syria, which has led to millions of refugees seeking asylum in Turkey, merits further attention. We aimed to study the rate of utilization of radiation therapy among Syrian refugees with cancer living in Turkey in an attempt to identify the contributing factors predictive of non-compliance with prescribed RT. Methods In this retrospective review of 14 institutional databases, Syrian refugee patients in Turkey with a cancer diagnosis from January 2015 to December 2019 who were treated with RT were identified. The demographic data, treatment compliance rates, and toxicity outcomes in these patients were surveyed. Variable predictors of noncompliance such as age, sex, diagnosis, treatment length, and toxicity were studied. The association between these variables and patient noncompliance was determined. Results We identified 10,537 patients who were diagnosed with cancer during the study period, of whom 1010 (9.6%) patients were treated with RT. Breast cancer (30%) and lung cancer (14%) were the most common diagnoses with up to 68% of patients diagnosed at an advanced stage (Stage III, IV). 20% of the patients were deemed noncompliant. Treatment with concurrent chemoradiotherapy (OR 1.61, 95% CI 1.06–2.46, p = 0.023) and living in a refugee camp (OR 3.62, 95% CI 2.43–5.19, p < 0.001) were associated with noncompliance. Age, sex and treatment length were not significantly associated with noncompliance. Conclusions Noncompliance with radiotherapy among Syrian refugees in Turkey remains an area of concern with a multitude of factors contributing to these alarming numbers. Further studies to better ascertain the finer nuances of this intricately complex problem and a global combination of efforts can pave the way to providing a solution.
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Affiliation(s)
- Mutlay Sayan
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street. ASB1 - L2, Boston, MA, 02115, USA.
| | - Mehmet Fuat Eren
- Marmara University Pendik Education and Research Hospital, Istanbul, Turkey
| | | | - Ayse Kotek
- Gaziantep Dr. Ersin Arslan Education and Research Hospital, Gaziantep, Turkey
| | | | - Ozge Duran
- Sanliurfa Mehmet Akif Inan Education and Research Hospital, Sanliurfa, Turkey
| | | | | | | | | | | | | | | | - Tugce Kutuk
- Malatya Education and Research Hospital, Malatya, Turkey
| | | | - Sukran Senyurek
- Kahramanmaras Necip Fazil City Hospital, Kahramanmaras, Turkey
| | | | - Swati Mamidanna
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Nisha Ohri
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Bruce Haffty
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
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8
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Lupieri S. 'Vulnerable' but not 'Valuable': Older refugees and perceptions of deservingness in medical humanitarianism. Soc Sci Med 2022; 301:114903. [PMID: 35339944 DOI: 10.1016/j.socscimed.2022.114903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 03/08/2022] [Accepted: 03/11/2022] [Indexed: 10/18/2022]
Abstract
In a crisis, there is widespread recognition and acceptance that not all lives can be saved. But whose lives can legitimately be saved and who decides? Recent scholarship has begun to examine how refugees perceived as 'vulnerable', such as women and children, are frequently prioritized over other groups in humanitarian responses. Such analyses, however, fail to adequately explain why some groups - such as older persons - are considered vulnerable and yet are largely neglected. Based on the case of older Syrian refugees in Jordan, this article critically examines the ways in which humanitarian health actors make sense of the humanitarian principle of 'impartiality' in the face of limited resources. Based on 61 interviews and observational data collected in Jordan between 2017 and 2019, my results show that humanitarians routinely classify older refugees as 'vulnerable' and in need of medical assistance. Yet I find that three neoliberal considerations - including perceptions of the reduced lifespan, disproportionate disease burden, and limited contributions to the economy of older refugees - make this demographic low 'value for money'. This article expands our understanding of how medical humanitarian understandings of 'deservingness' are increasingly shaped by market-driven logics, and how these (re)create ageist, gendered and racialized hierarchies within refugee health.
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Affiliation(s)
- Sigrid Lupieri
- Stanford University, Center for International Security and Cooperation, USA.
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Singh NS, Redman B, Broussard G, DeCamp M, Rayes D, Ho LS, Robinson WC, Sankari A, Maziak W, Rubenstein L. 'We will never give up': a qualitative study of ethical challenges Syrian health workers face in situations of extreme violence. DISASTERS 2022; 46:301-328. [PMID: 34309056 PMCID: PMC9987559 DOI: 10.1111/disa.12503] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Active conflict settings constitute challenging operating environments for humanitarian health organisations and workers. An emerging feature of some conflicts is direct violence against health workers, facilities, and patients. Since the start of the war in 2011, Syria has endured extreme and deliberate violent attacks on health facilities and workers. This paper reports on the findings from a qualitative study that examined the lived experiences of Syrian humanitarian health workers facing extreme ethical challenges and coping with moral distress. In-depth interviews were carried out with 58 front-line health workers in north-western and southern Syria. Participants described a number of ethical and operational challenges experienced while providing services in extreme conditions, as well as strategies used to deal with them. The complex intersection of personal and organisational challenges is considered and findings are linked to key ethical and humanitarian principles. Both practical recommendations and action steps are provided to guide humanitarian health organisations.
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Affiliation(s)
- Namrita S Singh
- PhD, MSc is Owner/Founder and Principal Advisor of Health Research Toolbox, LLC, and a Faculty Associate at the Department of International Health and Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, United States
| | - Brittany Redman
- MA, LPC is a Research Associate at Health Research Toolbox, LLC, and a Research Associate with the Humanitarian Assistance Applied Research Group, International Disaster Psychology Program, University of Denver, United States
| | - Grant Broussard
- MSPH is a Research Assistant at the Department of International Health and Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, United States
| | - Matthew DeCamp
- MD, PhD is an Associate Professor at the Center for Bioethics and Humanities and Division of General Internal Medicine, University of Colorado School of Medicine, United States
| | - Diana Rayes
- MHS is a Doctoral Student at the Department of International Health, Johns Hopkins Bloomberg School of Public Health, United States
| | - Lara S Ho
- PhD, RN is Director of Strategic Initiatives at the Health Unit, International Rescue Committee, and a Faculty Associate at the Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, United States
| | - W Courtland Robinson
- PhD is an Associate Professor at the Department of International Health and Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, United States
| | - Abdulghani Sankari
- MD, PhD is a Professor and Assistant Dean at the Department of Internal Medicine, Wayne State University-School of Medicine, and Director of the Department of Medical Education, Ascension Providence Hospital, United States
| | - Wasim Maziak
- MD, PhD is a Professor at the Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, United States
| | - Leonard Rubenstein
- JD is Professor of the Practice at the Center for Public Health and Human Rights and Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, and core faculty at Johns Hopkins Berman Institute of Bioethics, United States
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Lokot M, Bou-Orm I, Zreik T, Kik N, Fuhr DC, El Masri R, Meagher K, Smith J, Asmar MK, McKee M, Roberts B. Health System Governance in Settings with Conflict-Affected Populations: A Systhematic Review. Health Policy Plan 2022; 37:655-674. [PMID: 35325120 DOI: 10.1093/heapol/czac027] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 03/09/2022] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
Health system governance has been recognised as critical to strengthening healthcare responses in settings with conflict-affected populations. The aim of this review was to examine existing evidence on health system governance in settings with conflict-affected populations globally. The specific objectives were: (i) to describe the characteristics of the eligible studies; (ii) to describe the principles of health system governance; (iii) to examine evidence on barriers and facilitators for stronger health system governance; and (iv) to analyse the quality of available evidence. A systematic review methodology was used following PRISMA criteria. We searched six academic databases, and used grey literature sources. We included papers reporting empirical findings on health system governance among populations affected by armed conflict, including refugees, asylum seekers, internally displaced populations, conflict-affected non-displaced populations and post-conflict populations. Data were analysed according to the study objectives and informed primarily by the Siddiqi et al. (2009) governance framework. Quality appraisal was conducted using an adapted version of the Mixed Methods Appraisal Tool. Of the 6,511 papers identified through database searches, 34 studies met eligibility criteria. Few studies provided a theoretical framework or definition for governance. The most frequently identifiable governance principles related to participation and coordination, followed by equity and inclusiveness and intelligence and information. The least frequently identifiable governance principles related to rule of law, ethics and responsiveness. Across studies, the most common facilitators of governance were collaboration between stakeholders, bottom-up and community-based governance structures, inclusive policies, and longer-term vision. The most common barriers related to poor coordination, mistrust, lack of a harmonised health response, lack of clarity on stakeholder responsibilities, financial support, and donor influence. This review highlights the need for more theoretically informed empirical research on health system governance in settings with conflict-affected populations that draws on existing frameworks for governance.
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Affiliation(s)
- Michelle Lokot
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH
| | - Ibrahim Bou-Orm
- Saint Joseph University of Beirut, B.P. 11-5076 Riad El Solh, Beyrouth 1107 2180, Lebanon
| | - Thurayya Zreik
- War Child Holland, Verdun, Hussein Oweini street, Beirut, Lebanon
| | - Nour Kik
- Ministry of Public Health, Lebanese University Central Directorate, 4th Floor, Museum Square, Beirut 9800, Lebanon
| | - Daniela C Fuhr
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH
| | - Rozane El Masri
- War Child Holland, Verdun, Hussein Oweini street, Beirut, Lebanon
| | | | - James Smith
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH
| | | | - Martin McKee
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH
| | - Bayard Roberts
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH
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11
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Kutluk T, Koç M, Öner İ, Babalıoğlu İ, Kirazlı M, Aydın S, Ahmed F, Köksal Y, Tokgöz H, Duran M, Sullivan R. Cancer among syrian refugees living in Konya Province, Turkey. Confl Health 2022; 16:3. [PMID: 35101060 PMCID: PMC8805424 DOI: 10.1186/s13031-022-00434-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 01/06/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND With more than 3.6 million Syrian refugees Turkey hosts the world's largest number of Syrians. Considering the morbidity, mortality, and healthcare spending, cancer is one of the leading health and economic burden for patients and healthcare systems. However, very limited information available in the scientific literature to understand the burden and characteristics of cancer in countries hosting Syrian refugees. The aim of the present study is to evaluate the demographic and clinical characteristics, treatment outcome of Syrian cancer patients living in Konya, Turkey. METHODS We retrospectively reviewed medical records of Syrian cancer patients at three major institutions from 2005 to 2020. The information regarding demographic and clinical characteristics of patients were identified. The number of days between the first symptom and diagnosis was considered as the "diagnostic interval". Patients who failed to attend clinics within four weeks of appointment were assumed abandoned treatment. Survival curves were estimated using the Kaplan-Meier method. RESULTS We identified 230 adult and 38 children refugee diagnosed with cancer during the study period. With regards to adult patients, there were 114 (49.6%) male and 116 (50.4%) female. The median age at diagnosis was 52.4, 47.3 years for male, female respectively. The five most common cancer by site among all were; breast (24.8%), colorectal (10.9%), lung (7.4%), central nervous system (CNS) (7.0%), and stomach (5.2%). 93 (40.4%) had metastatic disease at diagnosis. The overall survival probability was 37.5% at five years for the adult population. Data were extracted for 20 boys and 18 girls with childhood cancer. Their median age at diagnosis was 5.8 and 6.0 years respectively. The three most common childhood cancer were; leukemias (21.1%), lymphomas (21.1%), and CNS (13.2%). Excluding leukemia, 13 (43.3%) of childhood cancer cases had the advanced disease at diagnosis. Three year survival probality was 69.5%. The median diagnostic interval for adult and childhood cancer was 96.5 (IQR = 53-165) and 23 (IQR = 13.5-59) days respectively. Twenty-one adults and four children had treatment abandonment. CONCLUSION This study contributes to understanding the burden of cancer among Syrian refugees living in Konya, growing health issue for refugees. Larger and prospective studies will help to measure the real burden and compare the difference in cancer risk factors, care, and outcomes among the refugee and host populations.
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Affiliation(s)
- Tezer Kutluk
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine and Cancer Institute, 06100, Ankara, Turkey.
| | - Mehmet Koç
- Provincial Directorate of Health Konya, Konya, Turkey
| | - İrem Öner
- Medical Oncology Unit, Ministry of Health City Hospital, Konya, Turkey
| | - İbrahim Babalıoğlu
- Radiation Oncology Unit, Ministry of Health City Hospital, Konya, Turkey
| | - Meral Kirazlı
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine and Cancer Institute, 06100, Ankara, Turkey
| | - Sinem Aydın
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine and Cancer Institute, 06100, Ankara, Turkey
| | - Fahad Ahmed
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine and Cancer Institute, 06100, Ankara, Turkey
| | - Yavuz Köksal
- Department of Pediatric Oncology, Selçuk University Meram Faculty of Medicine, Konya, Turkey
| | - Hüseyin Tokgöz
- Department of Pediatric Hematology, Necmettin Erbakan University Faculty of Medicine, Konya, Turkey
| | - Mustafa Duran
- Hematology Unit, Ministry of Health City Hospital, Konya, Turkey
| | - Richard Sullivan
- Institute of Cancer Policy, Conflict and Health Research Group, King's College London, London, UK
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12
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Abdel-Razeq H, Tamimi F, Abdel-Razeq N, El-Atrash M, Sharaf B, Mustafa R, Mansour R, Bater R. Late presentation and suboptimal treatment of breast cancer among Syrian refugees: a retrospective study. J Int Med Res 2021; 49:3000605211018448. [PMID: 34038215 PMCID: PMC8161870 DOI: 10.1177/03000605211018448] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objectives The crisis in Syria has had a profound impact on the entire region. In this study, we report the patterns of presentation and management of Syrian patients with breast cancer treated at our institution. Methods We retrospectively collected data on Syrian refugees treated for breast cancer over the past 10 years at our center. Management was compared against our approved clinical practice guidelines. Results A total of 113 patients were eligible and included. The median age (range) at diagnosis was 47 (21–84) years and most women presented with locally advanced or metastatic disease (n = 74, 65.5%). Breast-conserving surgery and breast reconstruction were performed in 27 (33.8%) and 11 (35.4%) patients, respectively. Only a few patients received targeted (35.5%) or advanced endocrine therapy (30.0%). In total, 37 (32.7%) patients had considerable deviations from our institutional treatment guidelines and had worse outcomes. Conclusions Syrian refugees with breast cancer present late, have more advanced-stage disease, and are more likely to receive delayed and suboptimal therapy. An international systematic approach for cancer care among such vulnerable populations is urgently needed.
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Affiliation(s)
- Hikmat Abdel-Razeq
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan.,School of Medicine, University of Jordan, Amman, Jordan
| | - Faris Tamimi
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Nayef Abdel-Razeq
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Maryam El-Atrash
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Baha' Sharaf
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Rawan Mustafa
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Razan Mansour
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Rayan Bater
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
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13
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Guo P, Alajarmeh S, Alarja G, Alrjoub W, Al-Essa A, Abusalem L, Mansour A, Sullivan R, Shamieh O, Harding R. Compounded trauma: A qualitative study of the challenges for refugees living with advanced cancer. Palliat Med 2021; 35:916-926. [PMID: 33765877 PMCID: PMC8114446 DOI: 10.1177/02692163211000236] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although palliative care is now an essential health service under Universal Health Coverage, ensuring access and appropriate care for refugees is a specific challenge for this large population. AIM To identify the needs and experiences of adult refugees in Jordan with advanced cancer and informal caregivers. DESIGN A qualitative study using semi-structured interviews. SETTING/PARTICIPANTS Participants were purposively sampled at two Jordanian hospitals to achieve heterogeneity by age, gender, country of origin, and primary diagnosis. RESULTS Twenty-nine refugees (22 patients, 7 caregivers) participated, and four themes were generated: (1) Psychological distress and sustaining social support. Refugees often experienced unmet psychosocial needs. However, psychosocial support was reported either absent or limited. (2) Knowledge and uncertainty. Lack of information and poor communication between healthcare providers and patients caused significant distress due to uncertainty. (3) Family anxiety and support roles. Being away from the home country cut patients and caregivers off from their wider social support network, which added increased anxiety and responsibilities to caregivers. (4) Compounded trauma and poverty. Many refugees have experienced trauma related to war that may affect their physical and mental health. They faced serious financial crises caused by the rising cost of medicines and treatment. CONCLUSIONS This study reveals the impact of fractured families and networks on social support in advanced cancer, and the compounding trauma of the disease for refugees. Detailed person-centred assessment and emphasis on psychosocial support is essential, and home-based care should not presume community support for patients to remain at home.
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Affiliation(s)
- Ping Guo
- School of Nursing, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Sawsan Alajarmeh
- Center for Palliative & Cancer Care in Conflict (CPCCC), King Hussein Cancer Center (KHCC), Amman, Jordan
| | - Ghadeer Alarja
- Department of Palliative Medicine, King Hussein Cancer Center (KHCC), Amman, Jordan
| | - Waleed Alrjoub
- Center for Palliative & Cancer Care in Conflict (CPCCC), King Hussein Cancer Center (KHCC), Amman, Jordan
| | - Ayman Al-Essa
- Center for Palliative & Cancer Care in Conflict (CPCCC), King Hussein Cancer Center (KHCC), Amman, Jordan
| | | | - Asem Mansour
- Chief Executive Office, King Hussein Cancer Center (KHCC), Amman, Jordan
| | | | - Omar Shamieh
- Department of Palliative Medicine, King Hussein Cancer Center (KHCC), Amman, Jordan.,College of Medicine, the University of Jordan, Amman, Jordan
| | - Richard Harding
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
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Al Qadire MI, Alomari K. Syrian Refugees in Jordan: Barriers to Receiving Optimal Cancer Care. Clin J Oncol Nurs 2020; 24:707-710. [DOI: 10.1188/20.cjon.707-710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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15
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Risks of cancer in the Rohingya community of Bangladesh: An issue still remains unaddressed. PUBLIC HEALTH IN PRACTICE 2020; 1:100040. [PMID: 36101689 PMCID: PMC9461531 DOI: 10.1016/j.puhip.2020.100040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 09/11/2020] [Indexed: 11/21/2022] Open
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16
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Luft H, Perzan M, Mitchell R, Schmidt A. An integrative literature review of barriers and facilitators to cervical cancer screening among refugee women in the United States. Health Care Women Int 2020; 42:992-1012. [PMID: 32814006 DOI: 10.1080/07399332.2020.1803872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Refugee women experience disproportionally high cervical cancer-related mortality. In this integrative review, we identify and discuss factors related to cervical cancer screening among refugee women in the US according to the Social Ecological Model. Two qualitative and three quantitative studies met inclusion criteria. Individual-level factors include English-language ability, availability, and individual knowledge, attitudes, and beliefs. Interpersonal-level factors include interactions with family/friends, provider, and community health worker. Community-, organization-, and policy-level factors include sociocultural values, transportation, ability to navigate the healthcare system, and health insurance. We discuss findings in the context of related reviews and applicability to other global settings.
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Affiliation(s)
- Heidi Luft
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Mireille Perzan
- Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Rita Mitchell
- Advocate Aurora Library Network, Advocate Aurora Health, Milwaukee, Wisconsin, USA
| | - Austin Schmidt
- Milwaukee Global Health Consortium, Milwaukee, Wisconsin, USA
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17
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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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18
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Ilbawi A, Slama S. Cancer care for refugees: time to invest in people and systems. Lancet Oncol 2020; 21:604-605. [DOI: 10.1016/s1470-2045(20)30163-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 03/04/2020] [Indexed: 10/24/2022]
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