London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, United Kingdom.
Syrian American Medical Society (SAMS), 1012 14th St. NW, Suite 1500, Washington, DC, 20005, United States.
Soc Sci Med. 2024 Nov;361:117364. doi: 10.1016/j.socscimed.2024.117364. Epub 2024 Sep 21.
Women with breast cancer in northwest Syria, an area of protracted armed conflict, face multiple intersecting challenges to accessing care which may relate to gender, social structures, and financial constraints. Our aim was to explore the perspectives of women with breast cancer in northwest Syria about the impact of their diagnosis and experiences of accessing care.
Women who accessed diagnosis or clinical care at the Syrian American Medical Society (SAMS) oncology centre in Idlib city during 2022 were identified from hospital records; they were invited to participate in semi-structured interviews conducted in Arabic by four local female-trained researchers. Participation was voluntary and informed consent was sought. Semi-structured interviews were conducted in August and September 2022 until thematic saturation was reached. Data were audio recorded and transcribed in Arabic before translation and thematic analysis using Nvivo to identify key emerging themes.
22 women with breast cancer were interviewed. Findings were categorised into three themes: 1. Challenges to accessing oncology care in northwest Syria 2. Interactions with healthcare workers 3. The role of community and society. All participants noted the financial strains which the breast cancer diagnosis placed on them and their families. Most also noted the additional strains of travelling long distances, either in northwest Syria or to Turkey, where referral would entail additional costs, bureaucracy or isolation from family or social support. Some participants described social impacts including the expectation that they would continue with household chores and childcare even while ill. Patients reported that strong faith, having children, compassion from healthcare staff and peer support as being important factors for coping with their diagnosis and treatment.
Though there have been improvements to breast cancer care in northwest Syria, stock-outs and the lack of availability of radiotherapy may still force women to travel to Turkey for further investigations or treatment. Our findings suggest increased support for women with breast cancer as well as their families is required. This work is a starting point for future research on this topic both in northwest Syria and other areas in Syria.
在叙利亚西北部这个长期武装冲突地区，患有乳腺癌的女性在获取治疗方面面临着多种相互交织的挑战，这些挑战可能与性别、社会结构和经济限制有关。我们的目的是探讨叙利亚西北部患有乳腺癌的女性对其诊断和获取治疗的经历所产生的影响的看法。
我们从医院记录中确定了 2022 年在伊德利卜市的叙利亚美国医学协会（SAMS）肿瘤中心接受诊断或临床治疗的患有乳腺癌的女性；邀请她们参加由四名当地女性培训的研究人员用阿拉伯语进行的半结构式访谈。参与是自愿的，并征求了知情同意。2022 年 8 月和 9 月进行了半结构式访谈，直到达到主题饱和。数据以阿拉伯语进行音频记录和转录，然后使用 Nvivo 进行主题分析，以确定主要的新兴主题。
共对 22 名患有乳腺癌的女性进行了访谈。调查结果分为三个主题：1. 在叙利亚西北部获取肿瘤学治疗的挑战；2. 与医疗保健工作者的互动；3. 社区和社会的作用。所有参与者都注意到乳腺癌诊断给他们和他们的家庭带来的经济压力。大多数人还指出，长途旅行的额外压力，无论是在叙利亚西北部还是在土耳其，转诊都需要额外的费用、官僚主义或与家人或社会支持隔离。一些参与者描述了社会影响，包括尽管患病，她们仍期望继续承担家务和照顾孩子的责任。患者报告说，坚定的信仰、有孩子、医护人员的同情心和同伴支持是应对诊断和治疗的重要因素。
尽管叙利亚西北部的乳腺癌治疗有所改善，但缺货和缺乏放疗可能仍迫使女性前往土耳其进行进一步的检查或治疗。我们的研究结果表明，需要为患有乳腺癌的女性及其家人提供更多的支持。这项工作是对叙利亚西北部和其他叙利亚地区这一主题的未来研究的一个起点。
