Access to Advanced Cancer Care Services in the West Bank-occupied Palestinian Territory

Overview

Journal Front Oncol

Specialty Oncology

Date 2023 Apr 3

PMID 37007067

Authors

Suzan Mitwalli

Weeam Hammoudeh

Rita Giacaman

Richard Harding

Affiliations

Soon will be listed here.

Abstract

Introduction: Universal Health Coverage (UHC) identifies the provision of palliative care for people with advanced disease as an essential health service. Palliative care is also stipulated as a human right under existing covenants. Oncology services provided by the Palestinian Authority under Israeli military occupation are limited to surgery and chemotherapy treatment. Our study aimed to describe the experiences of patients with advanced-stage cancer in the West Bank in accessing oncology services and meeting their health care needs.

Methodology: We conducted a qualitative study among adult patients diagnosed with advanced lung, colon, or breast cancer in three Palestinian governmental hospitals, and with oncologists. Thematic analysis was conducted on the verbatim interview transcripts.

Results: The sample consisted of 22 Palestinian patients (10 men and 12 women) and 3 practicing oncologists. The findings reveal that cancer care is fragmented, with limited access to the services needed. Patients face referral delays in accessing treatment which worsen their health condition in some cases. Some patients reported difficulties in getting Israeli permits to access radiotherapy treatment in East-Jerusalem, and others experienced interruptions of their chemotherapy treatment sessions due to the unavailability of chemotherapy medications caused by Israeli-side delays. Other reported problems were related to the Palestinian health system and service delivery and quality, including fragmentation of services, infrastructure issues, and unavailability of medications. Advanced diagnostic services and palliative care are almost absent at Palestinian governmental hospitals, and patients need to seek these services in the private sector.

Conclusion: The data demonstrate specific access restrictions to cancer care in the West Bank due to Israeli military occupation of Palestinian land. This affects all stages of the care pathway, from restricted diagnosis services, to limited treatment and then poor availability of palliative care. Cancer patients will continue to suffer if the root causes of these structural constraints are not addressed.

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References

Farmer P, Frenk J, Knaul F, Shulman L, Alleyne G, Armstrong L . Expansion of cancer care and control in countries of low and middle income: a call to action. Lancet. 2010; 376(9747):1186-93. DOI: 10.1016/S0140-6736(10)61152-X. View

Abu-Odah H, Molassiotis A, Liu J . Analysis of the unmet needs of Palestinian advanced cancer patients and their relationship to emotional distress: results from a cross-sectional study. BMC Palliat Care. 2022; 21(1):72. PMC: 9106510. DOI: 10.1186/s12904-022-00959-8. View

Khader Y, Sharkas G, Arkoub K, Alfaqih M, Nimri O, Khader A . The Epidemiology and Trend of Cancer in Jordan, 2000-2013. J Cancer Epidemiol. 2018; 2018:2937067. PMC: 6207872. DOI: 10.1155/2018/2937067. View

Rosenthal F . A comparison of health indicators and social determinants of health between Israel and the Occupied Palestinian Territories. Glob Public Health. 2020; 16(3):431-447. DOI: 10.1080/17441692.2020.1808037. View

Sirohi B, Chalkidou K, Pramesh C, Anderson B, Loeher P, El Dewachi O . Developing institutions for cancer care in low-income and middle-income countries: from cancer units to comprehensive cancer centres. Lancet Oncol. 2018; 19(8):e395-e406. DOI: 10.1016/S1470-2045(18)30342-5. View

Abo Al-Shiekh S, Alajerami Y, Etewa B, Elsous A . System Delay in Breast Cancer Diagnosis in Gaza Strip, Palestine. J Oncol. 2019; 2019:5690938. PMC: 6927013. DOI: 10.1155/2019/5690938. View

Sahloul E, Salem R, Alrez W, AlKarim T, Sukari A, Maziak W . Cancer Care at Times of Crisis and War: The Syrian Example. J Glob Oncol. 2017; 3(4):338-345. PMC: 5560458. DOI: 10.1200/JGO.2016.006189. View

Leone T, Alburez-Gutierrez D, Ghandour R, Coast E, Giacaman R . Maternal and child access to care and intensity of conflict in the occupied Palestinian territory: a pseudo longitudinal analysis (2000-2014). Confl Health. 2019; 13:36. PMC: 6686248. DOI: 10.1186/s13031-019-0220-2. View

Iragorri N, de Oliveira C, Fitzgerald N, Essue B . The Out-of-Pocket Cost Burden of Cancer Care-A Systematic Literature Review. Curr Oncol. 2021; 28(2):1216-1248. PMC: 8025828. DOI: 10.3390/curroncol28020117. View

10.

Mumba J, Kasonka L, Owiti O, Andrew J, Lubeya M, Lukama L . Cervical cancer diagnosis and treatment delays in the developing world: Evidence from a hospital-based study in Zambia. Gynecol Oncol Rep. 2021; 37:100784. PMC: 8165546. DOI: 10.1016/j.gore.2021.100784. View

11.

Sleeman K, Gomes B, de Brito M, Shamieh O, Harding R . The burden of serious health-related suffering among cancer decedents: Global projections study to 2060. Palliat Med. 2020; 35(1):231-235. PMC: 7797611. DOI: 10.1177/0269216320957561. View

12.

Sleeman K, de Brito M, Etkind S, Nkhoma K, Guo P, Higginson I . The escalating global burden of serious health-related suffering: projections to 2060 by world regions, age groups, and health conditions. Lancet Glob Health. 2019; 7(7):e883-e892. PMC: 6560023. DOI: 10.1016/S2214-109X(19)30172-X. View

13.

Mired D, Johnson S, Tamamyan G . Cancer disparities in war-torn and post-war regions. Nat Rev Cancer. 2020; 20(7):359-360. DOI: 10.1038/s41568-020-0274-x. View

14.

Unger-Saldana K . Challenges to the early diagnosis and treatment of breast cancer in developing countries. World J Clin Oncol. 2014; 5(3):465-77. PMC: 4127616. DOI: 10.5306/wjco.v5.i3.465. View

15.

Hui D, Bruera E . Integrating palliative care into the trajectory of cancer care. Nat Rev Clin Oncol. 2015; 13(3):159-71. PMC: 4772864. DOI: 10.1038/nrclinonc.2015.201. View

16.

Batniji R, Rabaia Y, Nguyen-Gillham V, Giacaman R, Sarraj E, Punamaki R . Health as human security in the occupied Palestinian territory. Lancet. 2009; 373(9669):1133-43. DOI: 10.1016/S0140-6736(09)60110-0. View

17.

Abdul-Sater Z, Menassa M, Achi N, Abdul-Khalek R, Abu-Sittah G, Mukherji D . Strengthening capacity for cancer research in conflict settings: key informant insights from the Middle East. Ecancermedicalscience. 2021; 14:1153. PMC: 7864685. DOI: 10.3332/ecancer.2020.1153. View

18.

Cazap E, Magrath I, Kingham T, Elzawawy A . Structural Barriers to Diagnosis and Treatment of Cancer in Low- and Middle-Income Countries: The Urgent Need for Scaling Up. J Clin Oncol. 2015; 34(1):14-9. PMC: 4871996. DOI: 10.1200/JCO.2015.61.9189. View

19.

Guo P, Alajarmeh S, Alarja G, Alrjoub W, Al-Essa A, Abusalem L . Compounded trauma: A qualitative study of the challenges for refugees living with advanced cancer. Palliat Med. 2021; 35(5):916-926. PMC: 8114446. DOI: 10.1177/02692163211000236. View

20.

Price A, Ndom P, Atenguena E, Mambou Nouemssi J, Ryder R . Cancer care challenges in developing countries. Cancer. 2012; 118(14):3627-35. DOI: 10.1002/cncr.26681. View