Basha Lena, Ahmed Hamza, Hamze Mohamed, Ali Amaar Awais, Alahdab Fares, Marzouk Manar, Sullivan Richard, Abbara Aula
Syrian American Medical Society, Washington, DC, US.
Imperial College London, London, UK.
BMC Cancer. 2024 Dec 18;24(1):1537. doi: 10.1186/s12885-024-13256-9.
Armed conflict can disrupt oncology care profoundly, resulting in worsened health outcomes for cancer patients. Syria has endured armed conflict for over a decade, resulting in a severe breakdown of its healthcare services. The aim of this systematic review was to assess the available evidence on the burden of cancer and oncology services in Syria and how they have been affected during the conflict.
Eight academic and six grey literature databases were searched for English- and Arabic-language studies published from March 2011 until February 2024. Studies reporting any outcomes relating to the burden of cancer or the state of oncology services in wartime Syria were considered for inclusion, although case reports and scoping reviews were excluded. A narrative synthesis of findings was performed.
Of 5,801 studies identified, 28 studies from academic (23) and grey literature (5) were eligible. Papers which reported on the burden of cancer showed an overall increase in cancer incidence and mortality between 2012 and 2022 (most recent data available). Most services were noted to be concentrated in Syria's capital, Damascus. The main identified themes related to the challenges of providing oncology services with staff shortages, chemotherapeutic drug shortages, insufficient radiotherapy services, and a lack of screening and palliative care noted.
There is insufficient high-quality exploration of the burden of cancer and the state of oncology services across Syria in academic and grey literature. Syria's health system is divided, creating disparities in access to oncology services, most of which are concentrated in Damascus, exacerbating pre-existing inequalities. The sparsity of robust data reinforces the need for high-quality data, including the use of national or other cancer registries with data from all regions of Syria, including those under opposition control. As the country rebuilds its healthcare systems, policymakers should focus on addressing inequities in oncology service availability to support equity of services.
武装冲突会严重扰乱肿瘤护理，导致癌症患者的健康状况恶化。叙利亚经历了十多年的武装冲突，其医疗服务遭到严重破坏。本系统评价的目的是评估关于叙利亚癌症负担和肿瘤服务状况的现有证据，以及它们在冲突期间受到的影响。
检索了8个学术数据库和6个灰色文献数据库，查找2011年3月至2024年2月发表的英文和阿拉伯文研究。纳入报告战时叙利亚癌症负担或肿瘤服务状况相关任何结果的研究，但排除病例报告和范围综述。对研究结果进行了叙述性综合分析。
在识别出的5801项研究中，有28项来自学术文献（23项）和灰色文献（5项）的研究符合条件。报告癌症负担的论文显示，2012年至2022年（可获得的最新数据）期间癌症发病率和死亡率总体上升。大多数服务集中在叙利亚首都大马士革。确定的主要主题涉及提供肿瘤服务面临的挑战，包括人员短缺、化疗药物短缺、放疗服务不足以及缺乏筛查和姑息治疗。
学术文献和灰色文献对叙利亚全国癌症负担和肿瘤服务状况的高质量探索不足。叙利亚的卫生系统四分五裂，导致肿瘤服务可及性存在差异，其中大部分集中在大马士革，加剧了原有的不平等。可靠数据的稀缺凸显了高质量数据的必要性，包括使用国家或其他癌症登记处，收集来自叙利亚所有地区（包括反对派控制地区）的数据。随着该国重建其医疗系统，政策制定者应专注于解决肿瘤服务可及性方面的不平等问题，以支持服务公平性。
