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. 2020 Mar 5:14:1018.
doi: 10.3332/ecancer.2020.1018. eCollection 2020.

Cancer care in times of conflict: cross border care in Pakistan of patients from Afghanistan

Muhammed Aasim Yusuf  1   2 , Shoaib Fahad Hussain  3   2 , Faisal Sultan  1 , Farhana Badar  1 , Richard Sullivan  3
Affiliations

Cancer care in times of conflict: cross border care in Pakistan of patients from Afghanistan

Muhammed Aasim Yusuf et al. Ecancermedicalscience. .

Abstract

Armed conflict in Afghanistan has continued for close to 40 years and has devastated its health infrastructure. The lack of a cancer care infrastructure has meant that many Afghans seek cancer care in neighbouring countries, like Pakistan. There remains a significant lack of empirical data on the new therapeutic geographies of cancer in contemporary conflicts. This retrospective single centre study explores the therapeutic and clinical geographies of Afghan cancer patients who were treated at the Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH&RC) in Lahore, Pakistan over a 22-year-period (1995 to 2017) covering major periods of conflict and relative peace. Data was available for 3,489 Afghan patients who received treatment at SKMCH&RC. The mean age at presentation was 42.7 years, and 60% were men. 30.2% came from Kabul and Nangarhar districts of Afghanistan, which have relatively short travel times to Pakistan, but patients from all parts of Afghanistan migrated to SKMCH&RC for treatment. Overall, 34.1% were diagnosed with upper gastrointestinal malignancies and 55.7% presented with late stage III/IV cancer. A wide range of treatments were provided, with 25.4% of patients receiving a combination of chemotherapy and radiation treatment. 52.7% of all patients were lost to follow-up. Outcomes were more favourable for children with cancer, 42% of whom had a complete response to therapy. Complex migration patterns, mixed political economies (refugees, forced and unforced migrants) and models of care that must be adapted to the realities of the patients rather than notional international standards all reflect the new therapeutic geographies that long-term conflict creates. This requires significant new domestic and international (e.g., United Nations High Commissioner for Refugees) policy and practises for providing cancer care in today's contemporary conflict ecosystems that frequently cross national borders.

Keywords: Afghanistan; Pakistan; cancer; conflict and health; global health; migration.

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Conflict of interest statement

None to declare.

Figures

Figure A1.
Figure A1.. Distribution by treatment strategy in paediatric patients.
Figure 1.
Figure 1.. Afghan migrants treated at SKMCH&RC (n = 3,489) from 1995 to 2017. (A) Age distribution. (B) Frequency of Afghan patients by year.
Figure 2.
Figure 2.. Distribution of patients by province of origin in Afghanistan. (A) Overall. (B) Paediatric only.
Figure 3.
Figure 3.. Distribution by site. (A) Overall (B) Paediatric. ALL: acute lymphoblastic leukaemia; CML: chronic myeloid leukaemia; CNS: central nervous system; NHL: non-Hodgkin lymphoma.
Figure 4.
Figure 4.. Distribution by treatment strategy.
See this image and copyright information in PMC

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