War and oncology: cancer care in five Iraqi provinces impacted by the ISIL conflict

Integrating cancer into crisis: a global vision for action from WHO and partners

More than a billion people live in fragile, conflict-affected, and vulnerable settings requiring humanitarian support, where cancer is a substantial health issue. Despite its substantial effect on populations, cancer care remains underprioritised in emergency preparedness and response frameworks and humanitarian operational planning. This Policy Review summarises the perspectives and actionable recommendations from the First Global High-Level Technical Meeting on Non-communicable Diseases in Humanitarian Settings, with a focus on cancer. The paper highlights the challenges of providing cancer care in fragile, conflict-affected, and vulnerable settings and proposes a comprehensive roadmap to address both immediate and long-term needs of patients with cancer living in these settings. Key solutions include: integrating the cancer care continuum into national preparedness and response plans to enhance health-care system resilience; integrating cancer into humanitarian responses efforts; addressing the specific needs of paediatric patients with cancer; improving cancer intelligence and surveillance systems; and developing strategies to navigate the logistical and financial challenges of providing cancer care during crises. Additionally, the paper outlines practical actions and next steps for international cooperation needed to drive a shift in global health priorities and elevate cancer in the global health security agenda. We hope the presented notions will help prevent millions of avoidable deaths among people with cancer.

Provision of supportive care by an NGO in the face of a dual challenge: cancer and wartime

PURPOSE

In this study, we explored the work of Halasartan (Stop Cancer), an Israeli nongovernmental organization (NGO) and unique social support network for cancer patients and survivors aged 18-44, during a war period. Drawing on the conservation of resources (COR) theory, we examined whether self-efficacy, social support, psychological distress, and participation in activities that were geared toward alleviating the war situation at Time 1 (T1) would predict engagement in such activities at Time 2 (T2).

METHODS

A longitudinal design with two time-points was used, and NGO members completed self-report questionnaires. At T1, the cohort comprised 250 members (cancer patients/ survivors); at T2, there were 213. However, only 90 NGO members completed the questionnaires at both time-points.

RESULTS

A significant reduction in psychological distress was observed over time among participants engaged in the NGO's activities, but no differences were observed in participants' self-efficacy or social support. Moreover, participation in NGO activities during wartime at T2 was predicted by biological sex (female), lower self-efficacy, and participation in NGO activities at T1.

CONCLUSION

Halasartan (Stop Cancer) played a pivotal role in offering a sense of normalcy, community, and support to young-adult cancer patients and survivors during a period of war. The study underscores the essential nature of NGO activities tailored to the unique needs of this demographic, particularly in times of crisis. A broader implementation of such supportive interventions to enhance the well-being of vulnerable populations is suggested.

Assessment of psycho-oncology in the Middle East and North Africa region: a systematic review and meta-analysis

BACKGROUND

The Middle East and North Africa (MENA) region is expected to witness a significant increase in the burden of cancer. Contrary to Western literature, the burden of psycho-oncology is yet to be established within the MENA region. This study reviews all available evidence characterizing the psychological burden among patients with cancer across the MENA region.

METHODS

We systematically explored the PubMed/MEDLINE, Cochrane/CENTRAL, and Web of Science (WoS) databases for reports on the psychiatric burden among patients with cancer residing within the MENA region from January 2000 until January 2023. Raw proportion were extracted and analyzed using a random-effects model.

FINDINGS

Eighty-three studies comprised of 16 810 participants, representing 14 countries, met our inclusion criteria. Across the MENA region, the prevalence of depression, anxiety, and distress were 44% (95% CI, 39%-50%), 47% (95% CI, 40%-54%), and 43% (95% CI, 30%-56%), respectively. Prevalence of depression was significantly different across countries, with Palestine (73%; 95% CI, 42%-91%) reporting the highest rate while Morocco (23%; 95% CI, 7%-56%) reported the lowest. Similarly, anxiety significantly differed across MENA nations ranging from 64% (95% CI, 3%-99%) in Morocco to 28% (95% CI, 18%-42%) in Tunisia. Rates of depression and anxiety were significantly different across measurement tools but not between Arabic-speaking versus Persian/Farsi-speaking countries. Meta-regression models showed that neither publication year nor age affected the prevalence of both anxiety and depression (P = .374 and .091 for depression and P = .627, and .546 for anxiety, respectively).

INTERPRETATION

We report an abnormally high rate of psychiatric burden among patients with cancer in the MENA region. Thus, establishing appropriate psycho-oncologic interventions within the MENA region is of utmost importance.

HealthCare Access Barrier (HCAB) framework for the barriers to cancer care during conflicts: perspective from Iraq

The Iraqi population has lived under four decades of conflicts, warfare and political instability. The health consequences of the protracted conflict continue to persist. This work critically analyses Iraq's barriers to delivering and accessing cancer care during the conflicts that Iraq passed through from 1980 to 2017. To identify the barriers to accessing and delivering cancer care services, we used the HealthCare Access Barriers framework, which categorises the barriers into three groups: financial, structural and cognitive. Moreover, a structured search was performed in multidisciplinary databases. To produce a comprehensive body of literature, further materials were retrieved using alternative methods, such as hand-searching and snowballing. The key findings and themes identified in the literature were issues related to funding and affordability (within the financial), destruction and inaccessibility of facilities, therapeutic and diagnostic shortages, workforce and human resources and lack of national guidelines and awareness programmes (within the structural), awareness and knowledge and finally attitudes and beliefs (within the cognitive). These results demonstrated that the barriers to cancer care delivery are complex and inter-related. The financial and structural barriers were particularly intertwined with the protracted conflict, but this relationship was not demonstrable within the findings of the cognitive barriers. We concluded that the barriers facing the delivery and access to cancer care in Iraq are intertwined mainly with its protracted conflict. To ensure that future generations do not continue to pay the price of war, improved reconstructive efforts and further research are necessary.

First Global Summit on War and Cancer: The Hidden Impact of War on Cancer-Urging Global Action for Change

The 1st Global Summit on War and Cancer (GSWC) united leaders, medical professionals, policymakers, and advocates to address cancer issues in conflict zones featuring speakers from around 50 countries.

Enhancing Cancer Care Amid Conflict: A Proposal for Optimizing Oncology Services During Wartime

The landscape of cancer care within armed conflict zones is characterized by intricate challenges arising from disrupted health care systems, scarcity of resources, and population displacement. During times of war, the provision of cancer services is often disrupted, leading to significant challenges for oncologists and other health care providers. To optimize cancer services during wartime, several key priorities must be addressed. Focusing on needs assessment, treatment prioritization, drug supply chain, telemedicine, mobile clinics, cross-border collaborations, health care staff support, and continuity of care will enable health care systems to provide essential cancer services and mitigate the adverse impact of conflict on patients with cancer. This article delineates the pivotal key priorities for optimizing cancer services during wartime. It calls for collaborative action, the integration of technology, and holistic care approaches to safeguard the rights, well-being, and dignity of individuals confronting the dual challenges of cancer and conflict. By addressing these priorities, health care providers, policymakers, and stakeholders can collectively ensure that cancer services remain steadfast and compassionate even amid the turmoil of war. Thus, it may be possible to optimize cancer services during wartime, ensuring that patients with cancer continue to receive the care they need.

Cancer Research in Vulnerable Populations: A Call for Collaboration and Sustainability From MENAT Countries

PURPOSE

Cancer is a major burden across Middle East, North Africa, Türkiye (MENAT). Many MENAT countries experience multiple conflicts that compound vulnerabilities, but little research investigates the linkages between vulnerability and cancer research. This study examines the current level and the potential for cancer research among vulnerable populations in the MENAT region, aiming to provide direction toward developing a research agenda on the region's vulnerable populations.

METHODS

Expert-driven meetings were arranged among the 10 authors. After obtaining institutional review board approval, a self-administered online survey questionnaire was circulated to more than 500 cancer practitioners working in 22 MENAT countries.

RESULTS

Two hundred sixteen cancer practitioners across the MENAT region responded. Fifty percent of the respondents identified clinical research in vulnerable patients with cancer as a significant issue; 21.8% reported previous research experience that included vulnerable populations, and 60% reported encountering vulnerable populations in their daily clinical practice. The main barriers to conducting research were lack of funding (60%), protected time (42%), and research training (35%). More than half of the respondents believed that wars/conflicts constituted an important source of vulnerability. The most vulnerable cancer populations were the elderly, palliative/terminally ill, those with concomitant mental health-related issues, those with other chronic illnesses, and socioeconomically deprived patients.

CONCLUSION

Results support that a major effort is needed to improve cancer research among vulnerable cancer populations in the MENAT region. We call for interdisciplinary research that accounts for the region's unique, compounding, and cumulative forms of vulnerability. This cancer research agenda on different vulnerable populations must balance sociobehavioral studies that explore sociopolitical barriers to quality care and clinical studies that gauge and refine treatment protocols. Building a research agenda through collaboration and solidarity with international partners is prime time.