TY - JOUR
T1 - Cancer in Syrian refugees in Jordan and Lebanon between 2015 and 2017
AU - Spiegel, Paul B.
AU - Cheaib, Joseph G.
AU - Aziz, Saad Abdel
AU - Abrahim, Orit
AU - Woodman, Michael
AU - Khalifa, Adam
AU - Jang, Minyoung
AU - Mateen, Farrah J.
N1 - Funding Information:
Unsurprisingly, given the very different health-care systems in Jordan and Lebanon, 116 (95%) of the 122 approved applications were referred to the ECC from government hospitals in Jordan, but only 39 (14%) of the 282 approved applications were referred from government hospitals in Lebanon; Lebanon has a highly privatised health-care system. The mean cost per approved case in Jordan was higher ($1862 [SD 1861]) than the mean cost in Lebanon ($1525 [1612]), as was the medium cost per approved case ($1262 [IQR 635–2679] vs $1030 [469–1992]). Although these calculations might seem counterintuitive because Jordan has a socialised health-care system, the costs for patients' cancer treatments in Lebanon were kept artificially low because of the exclusion of expensive treatments, such as chemotherapy and radiotherapy, and because of Lebanon's standard operating procedures, which permitted 75% coverage of the requested costs for all refugees (229 [81%] of 282 patients with cancer and accepted applications received 75% of the requested costs for treatment; the remainder received more coverage for special circumstances). Conversely, Jordan's standard operating procedures did not set thresholds of payment; 100% of the requested costs were paid for in 65 (53%) of the 122 approved cases, whereas 49 (40%) received less than 75% of the requested costs. Nonetheless, the explicit preference for one-off interventions in the Jordanian ECC's standard operating procedures is reflected in the finding that the ECC partially approved (90% cost coverage) the majority of surgery applications (18 [64%] of 28). For the one patient in Lebanon for whom chemotherapy was provided, this treatment was the most expensive at $12 417. In Jordan, patients with the most expensive applications were those requiring combined therapies; however, the costs for these patients were still considerably lower than the one approved chemotherapy application in Lebanon. Beyond cancer treatment supported by the UNHCR, a few other options exist for refugees, including resettlement in a third country and gaining financial support from various charities and hospitals, such as the King Hussein Cancer Hospital in Amman , Jordan.
Funding Information:
FJM reports grant funding from the National Institutes of Health, the National Multiple Sclerosis Society, Fondation Pierre Fabre, the Charles Hood Foundation, and IQVIA (Health Outcomes), and personal consulting fees from the Gerson Lehrman Group, Genentech, and Biogen, outside of the submitted work. All other authors declare no competing interests.
Publisher Copyright:
© 2020 Elsevier Ltd
PY - 2020/5
Y1 - 2020/5
N2 - 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.
AB - 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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U2 - 10.1016/S1470-2045(20)30160-1
DO - 10.1016/S1470-2045(20)30160-1
M3 - Review article
C2 - 32359503
AN - SCOPUS:85083860027
VL - 21
SP - e280-e291
JO - The Lancet Oncology
JF - The Lancet Oncology
SN - 1470-2045
IS - 5
ER -