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. 2020 Feb:6:59-66.
doi: 10.1200/JGO.19.00281.

High-Cost Cancer Treatment Across Borders in Conflict Zones: Experience of Iraqi Patients in Lebanon

Mac Skelton  1 , Raafat Alameddine  2 , Omran Saifi  2 , Miza Hammoud  2 , Maya Zorkot  2 , Marilyne Daher  2 , Maya Charafeddine  2 , Sally Temraz  2 , Ali Shamseddine  2 , Layth Mula-Hussain  3 , Mohammed Saleem  4 , Kazim F Namiq  5 , Omar Dewachi  6 , Ghassan Abu Sitta  7 , Zahi Abdul-Sater  8 , Talar Telvizian  2 , Walid Faraj  9 , Deborah Mukherji  2
Affiliations

High-Cost Cancer Treatment Across Borders in Conflict Zones: Experience of Iraqi Patients in Lebanon

Mac Skelton et al. JCO Glob Oncol. 2020 Feb.

Abstract

Purpose: Conflict-induced cross-border travel for medical treatment is commonly observed in the Middle East. There has been little research conducted on the financial impact this has on patients with cancer or on how cancer centers can adapt their services to meet the needs of this population. This study examines the experience of Iraqi patients seeking care in Lebanon, aiming to understand the social and financial contexts of conflict-related cross-border travel for cancer diagnosis and treatment.

Patients and methods: After institutional review board approval, 60 Iraqi patients and caregivers seeking cancer care at a major tertiary referral center in Lebanon were interviewed.

Results: Fifty-four respondents (90%) reported high levels of financial distress. Patients relied on the sale of possessions (48%), the sale of homes (30%), and vast networks to raise funds for treatment. Thematic analysis revealed several key drivers for undergoing cross-border treatment, including the conflict-driven exodus of Iraqi oncology specialists; the destruction of hospitals or road blockages; referrals by Iraqi physicians to Lebanese hospitals; the geographic proximity of Lebanon; and the lack of diagnostic equipment, radiotherapy machines, and reliable provision of chemotherapy in Iraqi hospitals.

Conclusion: As a phenomenon distinct from medical tourism, conflict-related deficiencies in health care at home force patients with limited financial resources to undergo cancer treatment in neighboring countries. We highlight the importance of shared decision making and consider the unique socioeconomic status of this population of patients when planning treatment.

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Conflict of interest statement

Sally Temraz

Honoraria: Merck Sharp & Dohme

Travel, Accommodations, Expenses: Amgen, Merck

Ali Shamseddine

Consulting or Advisory Role: Bayer

Speakers’ Bureau: Novartis, Sanofi, Merck, Merck Sharp & Dohme, Amgen, Bayer, Pfizer

Research Funding: Bristol-Myers Squibb, Merck

Travel, Accommodations, Expenses: Amgen, Merck Sharp & Dohme, Merck, Algorithm

Kadhim F. Namiq

Travel, Accommodations, Expenses: Merck Sharp & Dohme Oncology

Deborah Mukherji

Consulting or Advisory Role: Merck Sharp & Dohme Oncology, Pfizer, Bristol-Myers Squibb, Astellas Pharma

Research Funding: Bristol-Myers Squibb (Inst), Merck Serono (Inst), Novartis (Inst)

Travel, Accommodations, Expenses: Amgen, Merck Serono

No other potential conflicts of interest were reported.

Figures

FIG 1
FIG 1
Chronology of cancer care development in Iraq. ISIL, Islamic State in Iraq and the Levant; UN, United Nations.
FIG 2
FIG 2
Iraqi cross-border travel for cancer care. Regional geography: Jordan, Lebanon, and Turkey have become hubs for patients from Iraq seeking cancer care.
FIG 3
FIG 3
Demographic and clinical characteristics of patients responding to prospective questionnaire. (A) Demographic and staging information. (B) Diagnosis/tumor type. ALL, acute lymphoblastic leukemia; AML, acute myeloid leukemia; CML, chronic myeloid leukemia.
FIG 4
FIG 4
Drivers of cross-border treatment from Iraq to Lebanon (thematic analysis of qualitative results). AUBMC, American University of Beirut Medical Center.
FIG 5
FIG 5
Demographic and disease profile characteristics of Iraqi patients treated at the American University of Beirut Medical Center (AUBMC) from 2013 to 2016. (A) Demographic and clinical information. (B) Tumor type distribution. (C) Lebanese or Iraqi patients diagnosed with advanced breast or prostate cancer at AUBMC.
See this image and copyright information in PMC

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