1
|
Shamieh O, Kutluk T, Fouad FM, Sullivan R, Mansour A. Editorial: Cancer care in areas of conflict. Front Oncol 2023; 13:1301552. [PMID: 38023225 PMCID: PMC10646180 DOI: 10.3389/fonc.2023.1301552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 10/12/2023] [Indexed: 12/01/2023] Open
Affiliation(s)
- Omar Shamieh
- Center for Palliative & Cancer Care in Conflict (CPCCC), King Hussein Cancer Centre (KHCC), Amman, Jordan
- Department of Palliative Care, King Hussein Cancer Centre (KHCC), Amman, Jordan
- Faculty of Medicine, the University of Jordan, Amman, Jordan
| | - Tezer Kutluk
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine and Cancer Institute, Ankara, Türkiye
| | - Fouad M. Fouad
- Department of Epidemiology & Population Health, the American University of Beirut, Beirut, Lebanon
| | - Richard Sullivan
- Institute of Cancer Policy & Conflict & Health Research Group, King’s College London, London, United Kingdom
| | - Asem Mansour
- Center for Palliative & Cancer Care in Conflict (CPCCC), King Hussein Cancer Centre (KHCC), Amman, Jordan
- Department of Radiology, King Hussein Cancer Centre (KHCC), Amman, Jordan
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Abdul-Sater Z, Menassa M, El Achi N, Abdul-Khalek RA, Abu-Sittah G, Mukherji D. Strengthening capacity for cancer research in conflict settings: key informant insights from the Middle East. Ecancermedicalscience 2021; 14:1153. [PMID: 33574898 PMCID: PMC7864685 DOI: 10.3332/ecancer.2020.1153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Indexed: 11/06/2022] Open
Abstract
Background Management of cancer in the Middle East and North Africa (MENA) region is accompanied by multiple challenges including heterogeneous access to early detection and treatment options and limited implementation of national cancer control plans. Furthermore, protracted armed conflicts across the region have had dramatic effects, including disruption of healthcare systems and the migration of healthcare professionals. Strengthening capacity for cancer research has been identified as a key intervention to correct data poverty, inform policy, manage limited resources and improve health outcomes. Objective The main objective of this study is to gain insights into the landscape, barriers and enablers of cancer training, research and care in the MENA region. Method We utilised purposive sampling to interview 16 key informants from a diverse academic, medical and research background originating from countries affected by conflicts, such as Lebanon, and from active conflict zones including Iraq and Syria. Results The themes that emerged from the interviews focused on the barriers to cancer care, barriers to cancer research and training, strengths and importance of cancer research and training recommendations. The detrimental effect of conflict on cancer provision and research was a cross-cutting sub-theme disrupting cancer care provision and research due to unsafe environments, fragmented facilities, absence of drugs and migration of personnel. When asked about perceived optimal training format for cancer research, most informants recommended a post-graduate, face-to-face training focusing on cancer research methods and concepts. Conclusion This study offers a unique insight into the barriers affecting cancer research and capacity-strengthening priorities from oncologists and researchers working in conflict-affected areas of the MENA region. These data will form the base for future capacity-strengthening initiatives addressing specific regional challenges.
Collapse
Affiliation(s)
- Zahi Abdul-Sater
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Marilyne Menassa
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Nassim El Achi
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | | | | | - Deborah Mukherji
- Naef K Basile Cancer Institute, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| |
Collapse
|
4
|
Adoch W, Garimoi CO, Scott SE, Okeny GG, Moodley J, Komakech H, Walter FM, Mwaka AD. Knowledge of cervical cancer risk factors and symptoms among women in a refugee settlement: a cross-sectional study in northern Uganda. Confl Health 2020; 14:85. [PMID: 33292345 PMCID: PMC7713037 DOI: 10.1186/s13031-020-00328-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 11/24/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND There are limited data on awareness of cervical cancer risk factors and symptoms among refugee populations living in Uganda. In this study, we sought to determine the awareness and knowledge of cervical cancer risk factors and symptoms among women in Palabek refugee settlement, northern Uganda. METHODS We conducted a cross-sectional study. 815 women (aged 18-60 years) were randomly selected using multistage sampling in Palabek refugee settlement. Data were collected using pre-tested, structured questionnaires. Logistic regression models were used to determine magnitudes of association between socio-demographic and health system factors, and knowledge on cervical cancer risk factors and symptoms. RESULTS The majority of participants (53%, n = 433) were young (18-29 years), married (68%, n = 553), and did not have formal employment (93%, n = 759). Less than half (40%, n = 325) had heard of cervical cancer. Of those who had heard, most recognized multiple male sexual partners, early onset of sexual intercourse and HPV infections as risk factors for cervical cancer (93%, n = 295; 89%, n = 283; and 86%, n = 271 respectively). Median knowledge score for risk factor recognition = 7 (IQR: 3-9). Median knowledge score for symptoms recognition = 7 (IQR: 1-10). Half of women (50%, n = 409) correctly recognized 7 to 11 symptoms of cervical cancer, with vaginal bleeding between menstrual periods, pelvic pain, and vaginal bleeding during/after sexual intercourse recognized by 58, 52 and 54% respectively. Single women (OR = 0.59 (95%CI: 0.38-0.94), and women that lived farther than 1 kilo meter from nearest health facility in South Sudan (OR = 0.36-0.49 (95%CI: 0.26-0.84) were less likely to be knowledgeable of symptoms of cervical cancer. CONCLUSION A significant proportion of women in Palabek refugee settlement had not heard about cervical cancer. Refugee health services providers could increase awareness of cervical cancer risk factors and symptoms through health education in order to promote risk reduction behaviours and guide women during symptoms appraisal. Single women and those who lived more than one kilo metre from nearest health facility in home country could be a priority group for awareness intervention in the settlement.
Collapse
Affiliation(s)
- Winnie Adoch
- School of Public Health, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Christopher Orach Garimoi
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Suzanne E. Scott
- Centre for Oral, Clinical & Translational Sciences, Faculty of Dentistry, Oral & Craniofacical Sciences, King’s College London, London, UK
| | - Geoffrey Goddie Okeny
- School of Public Health, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Jennifer Moodley
- Women’s Health Research Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road. Observatory, Cape Town, 7925 South Africa
- Cancer Research Initiative, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925 South Africa
| | - Henry Komakech
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Fiona M. Walter
- The Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
| | - Amos Deogratius Mwaka
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| |
Collapse
|
5
|
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).
Collapse
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.
| | | |
Collapse
|
6
|
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.
Collapse
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.
| |
Collapse
|
7
|
Abstract
The Syrian crisis, which started in 2011, has had a profound impact on the entire region. Jordan, with its limited resources, now has the second highest ratio of refugees to inhabitants in the world (89 to 1,000). The actual number of Syrians in Jordan is hotly contested: more than 630,776 refugees registered in November 2015 compared with 1,265,514 reported by the national census conducted at the same time. Although the numbers are slowly but steadily increasing, the number of patients with cancer who were registered by the Jordan Cancer Registry peaked in 2013 at 510 patients reported and subsequently slumped downward, which coincided with changes in funding as a result of the increasing strains on the Ministry of Health. Older individuals, women, and patients with advanced diseases were less likely to be registered. These findings overlap with data obtained from the authors’ own center registry. Using age- and sex-specific population-based incidence rates, we estimated that 869 Syrians are diagnosed with cancer in Jordan annually. Using diagnosis-specific cost records of the King Hussein Cancer Foundation, we estimated that the cost of their treatments is 15.6 million Jordan dinars (US$22.1 million).
Collapse
Affiliation(s)
- Asem Mansour
- All authors: King Hussein Cancer Center, Al-Jubeiha, Amman, Jordan
| | - Amal Al-Omari
- All authors: King Hussein Cancer Center, Al-Jubeiha, Amman, Jordan
| | - Iyad Sultan
- All authors: King Hussein Cancer Center, Al-Jubeiha, Amman, Jordan
| |
Collapse
|
8
|
Cancer Incidence Among Syrian Refugees in Turkey, 2012–2015. JOURNAL OF INTERNATIONAL MIGRATION AND INTEGRATION 2018. [DOI: 10.1007/s12134-018-0549-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
9
|
Soydan L, Demir AA, Tunaci A. Frequency of abnormal pulmonary computed tomography findings in asylum seeking refugees in Turkey. Int Health 2017; 9:118-123. [PMID: 28100704 DOI: 10.1093/inthealth/ihw057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 12/14/2016] [Indexed: 11/13/2022] Open
Abstract
Background Lungs are particularly vulnerable to both acute infections, including TB, and chronic diseases such as chronic obstructive pulmonary disease, as well as to malignancies, all of which require particular attention during war times in which health conditions are far from optimal. Methods This retrospective cross-sectional study included 1149 refugees that underwent thoracic computed tomography (CT) for respiratory symptoms between March 2013 and February 2015 in Turkey. Results At least one positive CT finding was seen in 231 (20.1%) of the patients. The most common findings were chronic pulmonary changes (n=197, 17.2%), followed by findings suggestive of infections (n=39, 3.4%), and mass/nodular lesions (n=16, 1.4%). The rates of the lesions suggestive of active TB and malignancy were 1.0% (n=11) and 0.7% (n=8), respectively. Age 55-64 years was an independent significant predictor for any CT lesion, chronic changes, mass lesions, and lesions suggestive of malignancy. Age>65 years was predictive of any CT lesion and chronic changes. Conclusions The findings of this study indicate the need for implementation of cost-effective screening strategies in refugees, particularly during war times. Screening for TB would improve disease control among both refugees and the host populations. Middle aged and older individuals, in particular, would benefit from more proactive screening tools and strategies for the early diagnosis of pulmonary malignancies and chronic lung diseases.
Collapse
Affiliation(s)
- Levent Soydan
- Department of Radiology, Haydarpasa Numune Research and Training Hospital, 34668, Istanbul, Turkey
| | - Ali Aslan Demir
- Department of Radiology, Capa Medical Faculty, Istanbul University, 34093, Istanbul, Turkey
| | - Atadan Tunaci
- Department of Radiology, Capa Medical Faculty, Istanbul University, 34093, Istanbul, Turkey
| |
Collapse
|
10
|
Martin DN, Lam TK, Brignole K, Ashing KT, Blot WJ, Burhansstipanov L, Chen JT, Dignan M, Gomez SL, Martinez ME, Matthews A, Palmer JR, Perez-Stable EJ, Schootman M, Vilchis H, Vu A, Srinivasan S. Recommendations for Cancer Epidemiologic Research in Understudied Populations and Implications for Future Needs. Cancer Epidemiol Biomarkers Prev 2017; 25:573-80. [PMID: 27196089 DOI: 10.1158/1055-9965.epi-15-1297] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 02/10/2016] [Indexed: 11/16/2022] Open
Abstract
Medically underserved populations in the United States continue to experience higher cancer burdens of incidence, mortality, and other cancer-related outcomes. It is imperative to understand how health inequities experienced by diverse population groups may contribute to our increasing unequal cancer burdens and disparate outcomes. The National Cancer Institute convened a diverse group of scientists to discuss research challenges and opportunities for cancer epidemiology in medically underserved and understudied populations. This report summarizes salient issues and discusses five recommendations from the group, including the next steps required to better examine and address cancer burden in the United States among our rapidly increasing diverse and understudied populations. Cancer Epidemiol Biomarkers Prev; 25(4); 573-80. ©2016 AACR SEE ALL ARTICLES IN THIS CEBP FOCUS SECTION, "MULTILEVEL APPROACHES TO ADDRESSING CANCER HEALTH DISPARITIES".
Collapse
Affiliation(s)
- Damali N Martin
- Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, Bethesda, Maryland.
| | - Tram Kim Lam
- Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, Bethesda, Maryland
| | - Katy Brignole
- Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, Bethesda, Maryland
| | - Kimlin T Ashing
- Center for Community Alliance for Research and Education, City of Hope Cancer Center, Duarte, California
| | - William J Blot
- Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, Tennessee. International Epidemiology Institute, Rockville, Maryland
| | - Linda Burhansstipanov
- Native American Cancer Research Corporation, Denver, Colorado. Native American Cancer Initiatives, Incorporated, Colorado
| | - Jarvis T Chen
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Mark Dignan
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky
| | - Scarlett Lin Gomez
- Cancer Prevention Institute of California, Fremont, California. Stanford Cancer Institute, Stanford, California
| | - Maria Elena Martinez
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California
| | - Alicia Matthews
- School of Nursing, University of Illinois at Chicago, Chicago, Illinois
| | - Julie R Palmer
- Slone Epidemiology Center, Boston University, Boston, Massachusetts
| | - Eliseo J Perez-Stable
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
| | - Mario Schootman
- College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri
| | - Hugo Vilchis
- Burrell College of Osteopathic Medicine/Burrell Institute for Health Policy & Research, Las Cruces, New Mexico
| | - Alexander Vu
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Shobha Srinivasan
- Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, Bethesda, Maryland
| |
Collapse
|
11
|
Otoukesh S, Mojtahedzadeh M, Figlin RA, Rosenfelt FP, Behazin A, Sherzai D, Cooper CJ, Nahleh ZA. Literature Review and Profile of Cancer Diseases Among Afghan Refugees in Iran: Referrals in Six Years of Displacement. Med Sci Monit 2015; 21:3622-8. [PMID: 26592372 PMCID: PMC4662241 DOI: 10.12659/msm.895173] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 08/04/2015] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND There is a paucity of research on the profile of cancers among displaced populations, specifically Afghan refugees in Iran. This study illustrates the pattern of cancers in this population, and highlights the challenges of cancer care in displaced people with the intent that this data will facilitate appropriate allocation of resources to improve care in this population. MATERIAL AND METHODS This was a retrospective cross-sectional study, in which we collected the demographics and profile of cancers among Afghan refugees from 2005 to 2010 from referrals to the United Nations High Commissioner for Refugees (UNHCR) offices in Iran. Accrued evidence by other studies published between January 1993 and July 2014 pertaining to cancer diagnoses in refugees from Afghanistan, Tibet, Syria, Jordan, and Iraq was reviewed. RESULTS Cancer diagnoses accounted for 3083 of 23 152 total referrals, with 49% female and 51% male cases; 23.3% were 0-17 years of age, 61.2% were 18-59, and 15.5% were above 60. The most common health referral for females and males (0-17) was malignant neoplasms of lymphatic and hematopoietic tissue, accounting for 34.2%. In the age groups 18-59 and above 60 for both male and females it was malignant neoplasm of the digestive system, occurring in 26.3% and 48.7%, respectively. CONCLUSIONS In the setting of humanitarian crises especially war, cancer diagnoses among refugees is a major health burden both on the host countries and the international community with serious implications considering the recent growing trend in the Middle Eastern countries. The prevalence of certain cancer diagnoses among refugees, like gastrointestinal, respiratory, breast, and genitourinary cancers necessitates a multidirectional approach, primarily aimed at prevention and early detection. International partnerships are essential for improvement in cancer surveillance service availability, and delivery of the standard of care, in an overall effort to reduce the human cost, monetary, and resource associated burdens of cancer. Recommendations to implement effective prevention and management goals as well as improved record keeping in the refugee setting and the acquisition of secure and sustainable funding sources should be implemented in collaboration with global humanitarian agencies like UNHCR.
Collapse
Affiliation(s)
- Salman Otoukesh
- Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX, U.S.A
| | - Mona Mojtahedzadeh
- Department of Psychiatry, Texas Tech University Health Sciences Center, El Paso, TX, U.S.A
| | - Robert A. Figlin
- Division of Hematology/Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, U.S.A
| | - Fred P. Rosenfelt
- Division of Hematology/Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, U.S.A
| | - Arash Behazin
- United Nations High Commissioner for Refugees, Tehran, Iran
| | - Dean Sherzai
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, U.S.A
| | - Chad J. Cooper
- Department of Internal Medicine/Gastroenterology, University of Kentucky, Lexington, KY, U.S.A
| | - Zeina A. Nahleh
- Division of Hematology/Oncology, Texas Tech University Health Sciences Center, El Paso, TX, U.S.A
| |
Collapse
|
12
|
Spiegel P, Khalifa A, Mateen FJ. Cancer in refugees in Jordan and Syria between 2009 and 2012: challenges and the way forward in humanitarian emergencies. Lancet Oncol 2014; 15:e290-7. [PMID: 24872112 DOI: 10.1016/s1470-2045(14)70067-1] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Treatment of non-communicable diseases such as cancer in refugees is neglected in low-income and middle-income countries, but is of increasing importance because the number of refugees is growing. The UNHCR, through exceptional care committees (ECCs), has developed standard operating procedures to address expensive medical treatment for refugees in host countries, to decide on eligibility and amount of payment. We present data from funding applications for cancer treatments for refugees in Jordan between 2010 and 2012, and in Syria between 2009 and 2011. Cancer in refugees causes a substantial burden on the health systems of the host countries. Recommendations to improve prevention and treatment include improvement of health systems through standard operating procedures and innovative financing schemes, balance of primary and emergency care with expensive referral care, development of electronic cancer registries, and securement of sustainable funding sources. Analysis of cancer care in low-income refugee settings, particularly in sub-Saharan Africa, is needed to inform future responses.
Collapse
Affiliation(s)
- Paul Spiegel
- Office of the United Nations High Commissioner for Refugees, Geneva, Switzerland.
| | - Adam Khalifa
- Office of the United Nations High Commissioner for Refugees, Damascus, Syria
| | - Farrah J Mateen
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| |
Collapse
|
13
|
Amara AH, Aljunid SM. Noncommunicable diseases among urban refugees and asylum-seekers in developing countries: a neglected health care need. Global Health 2014; 10:24. [PMID: 24708876 PMCID: PMC3978000 DOI: 10.1186/1744-8603-10-24] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 02/24/2014] [Indexed: 11/25/2022] Open
Abstract
With the increasing trend in refugee urbanisation, growing numbers of refugees are diagnosed with chronic noncommunicable diseases (NCDs). However, with few exceptions, the local and international communities prioritise communicable diseases. The aim of this study is to review the literature to determine the prevalence and distribution of chronic NCDs among urban refugees living in developing countries, to report refugee access to health care for NCDs and to compare the prevalence of NCDs among urban refugees with the prevalence in their home countries. Major search engines and refugee agency websites were systematically searched between June and July 2012 for articles and reports on NCD prevalence among urban refugees. Most studies were conducted in the Middle East and indicated a high prevalence of NCDs among urban refugees in this region, but in general, the prevalence varied by refugees’ region or country of origin. Hypertension, musculoskeletal disease, diabetes and chronic respiratory disease were the major diseases observed. In general, most urban refugees in developing countries have adequate access to primary health care services. Further investigations are needed to document the burden of NCDs among urban refugees and to identify their need for health care in developing countries.
Collapse
Affiliation(s)
- Ahmed Hassan Amara
- Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin Berlin, Spandauer Damm 130, Haus 10, Berlin D-14050, Germany.
| | | |
Collapse
|