Al-Bitar, Ahmad

e23211 Background: The Syrian conflict, ongoing since 2011, has significantly disrupted healthcare delivery, particularly in oncology. With the destruction of many regional cancer centers, access to care has become centralized in Damascus, home to Al Bairouni University Hospital—the nation’s primary cancer referral facility. This study examines the geographic distribution and stage at diagnosis of prostate cancer patients, highlighting post-conflict disparities in access and outcomes. Methods: We conducted a retrospective chart review of all prostate cancer patients diagnosed at Al Bairouni University Hospital between January 2022 and December 2024. Data on age, residency, and stage at diagnosis were extracted and analyzed descriptively. Results: A total of 859 patients were included, with a mean age of 69 years (SD 9). Only 47% (n = 405) of patients resided in Damascus or its suburbs (Rif-Dimashq), while the majority (53%, n = 462) traveled from other governorates—most notably Aleppo (8.5%), Hama (9.1%), Homs (8.4%), and Al-Hasakah (6.2%). This geographic pattern reflects the collapse of regional oncology services due to prolonged conflict.Alarmingly, 65% of patients (n = 507) were diagnosed with metastatic disease (stage IV), while only 16% and 19% presented with localized and regional stages, respectively. This contrasts sharply with global trends and suggests systemic gaps in early detection. Contributing factors may include the absence of structured screening programs, weak insurance system and primary care infrastructure, low prostate cancer awareness, fear of cancer diagnosis, financial barriers, and limited healthcare access in rural areas. Conclusions: This study reveals the deep, lingering effects of war on prostate cancer care in Syria. The centralization of oncology services places undue burden on patients traveling long distances for care, while the predominance of advanced-stage diagnoses underscores the need for robust early detection efforts. These findings support urgent investment in rebuilding regional cancer infrastructure, expanding community-based health services, and improving access to timely diagnosis and treatment as the country enters a phase of reconstruction.

1557 Background: Immunotherapy is now a standard-of-care treatment for lung cancer across most stages. Access to immunotherapy and molecular diagnostic tests in conflict-affected countries such as Syria remains poorly described. As the principal cancer center in Syria, Al-Bairouni University Hospital (ABUH) provides care for nearly three-quarters of all cancer cases nationally. We conducted this study to evaluate access to immunotherapy and molecular diagnostic services at ABUH. Methods: A mixed-methods study was performed between 2022 and 2024 at ABUH. This study included a retrospective cohort of all patients diagnosed with lung adenocarcinoma. Quantitative data included disease stage at diagnosis, molecular testing rates, and immunotherapy utilization. In addition, a qualitative patient survey was thematically analyzed to explore barriers to treatment access in a separate cohort of patients with mixed tumor types. Results: Among 2,920 patients diagnosed with lung cancer, 1,393 (47.7%) had lung adenocarcinoma. The median age at diagnosis was 61 years; 79.7% of patients were male. Smoking history was as follows: Current 792 (56.9%), Former 268 (19.2%), never smoked 318 (22.8%) At presentation, 3 patients (0.2%) had stage I disease, 40 (2.9%) stage II, 174 (12.5%) stage III, and 778 (55.8%) stage IV disease, staging was unknown for the rest of the patients. EGFR mutation testing was performed by ABUH for 226/1393 patients (16.2%) only, with positive results identified in 124 cases (8.9%). PD-L1 testing was conducted by ABUH in only 32/1393 patients (2.3%) and was positive in 23 (1.65%). Of all patients with lung adenocarcinoma, only 5 patients (0.6%) with stage IV disease received immunotherapy. All were treated with nivolumab. Thematic analysis of qualitative data (35 patients) revealed that high treatment costs and limited drug availability are the primary barriers to accessing immunotherapy. Conclusions: This study represents the first evaluation of access to immunotherapy for patients with lung cancer in Syria. Even at ABUH, the country's main cancer center, access to immunotherapy and molecular testing remains markedly limited. International collaboration is necessary to expand diagnostic infrastructure, standardize data reporting, and enhance financial protection mechanisms. These are critical steps toward achieving better cancer care in Syria.

Abstract Background: The diagnosis and treatment of breast cancer impose a significant psychological burden, which can include suicidal ideation. However, data from conflict-affected regions like Syria are scarce. This study aimed to determine the prevalence of suicidal thoughts and identify associated risk factors among Syrian patients with breast cancer. Methodology: An institution-based cross-sectional study was conducted at Al-Biruni University Hospital in Damascus, Syria. Between April and August 2025, a total of 319 breast cancer patients undergoing chemotherapy were recruited. Data were collected through structured face-to-face interviews and reviews of medical records. Standardized instruments included the Patient Health Questionnaire-2 (PHQ-2), the Multidimensional Scale of Perceived Social Support (MSPSS), and the Columbia-Suicide Severity Rating Scale (C-SSRS). Statistical analyses were used to identify factors associated with suicidal ideation. Results: The overall prevalence of suicidal ideation was 8.2%. Suicidal thoughts were significantly associated with depression (p=0.0014), anxiety (p<0.001), and low perceived family support (p=0.0293). Key clinical predictors included advanced disease stage (p=0.0275), metastatic disease (p=0.0251), and severe pain (p=0.0011). A higher prevalence was also noted in patients who had not undergone surgery (p=0.0057). Significant sociodemographic factors included being divorced (p=0.0117) and residency location (p=0.0039). Among those experiencing suicidal ideation, a small but significant portion progressed toward action, with approximately 5.2% to 5.6% reporting they had worked out details of a plan or had some intention of acting on their thoughts. Regarding deterrents, religious beliefs were the most common reason cited for not attempting suicide (58%), followed by personal reasons (46%). Conclusion: Suicidal ideation is a significant concern among Syrian breast cancer patients, strongly associated with psychological distress, advanced disease, severe pain, and specific sociodemographic vulnerabilities. These findings highlight the critical need to integrate mental health screening and targeted psychosocial support into routine oncological care, especially for high-risk individuals in this vulnerable population. Citation Format: A. Al-Bitar, M. Doyya, N. Battah, S. Achkar, F. Nahhat, M. Saifo. Suicidal Ideation and the Role of Social Support Among Breast Cancer Patients in Syria [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS5-12-30.

Abstract Background: In conflict zones like Syria, accessing cancer care presents immense challenges. However, there is a critical lack of data on the specific barriers patients face. This study aimed to document these obstacles for breast cancer patients in Syria following 14 years of civil war. We surveyed patients presenting for cancer care to better understand the challenges they faced. Methods: This cross-sectional study included adult patients with a confirmed breast cancer diagnosis presenting to Al-Bairouni University Hospital for care. Data was collected through face-to-face interviews using a structured questionnaire adapted for the Syrian context. The survey covered six key areas: Demographic & Clinical, Healthcare System Barriers, Financial Barriers, Geographic & Security barriers, Reasons for Diagnostic Delays, and Psychosocial Impact. Multivariate analysis via logistic regression was conducted to determine which responses were associated with a higher odds ratio (OR) of having a late-stage (III/IV) cancer diagnosis. Results: A total of 109 patients diagnosed with breast cancer were enrolled. The mean age was 51.4 years (±15.2 SD). Advanced diagnostics (CT/MRI/biopsy) and radiation therapy were inaccessible for 58% (n=63) and 63% (n=69) of patients. Systemic therapy drugs were "rarely" or "never" available for 33% (n=36) of patients, and 14% (n=15) reported waiting over three months for an appointment. The costs of medications "greatly" or "very greatly" impacted 86% (n=94) of patients. Over two-thirds of patients reported that essential pain control medications (e.g., morphine) were "rarely" or "never" available (66%, n=72). Nearly two-thirds (67%, n =73) reported that security concerns "greatly" or "somewhat" affected their ability to access treatment. An overwhelming 89% (n=97) of patients reported a negative psychological impact from their treatment course. Patient responses associated with a higher OR of late-stage cancer diagnosis are present in Table 1. Conclusions: Breast cancer patients in Syria confront overwhelming systemic, financial, and security barriers that compromise their care and contribute to advanced diagnoses. The findings highlight a profound humanitarian crisis and underscore the urgent need for targeted public health and aid interventions to support cancer care in conflict settings. Citation Format: A. Al-Bitar, A. Kouli, F. Nahhat, M. Saifo. Systemic Barriers to Breast Cancer Care in Conflict-Affected Syria [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS5-11-14.

813 Background: Epidemiological data on gastrointestinal (GI) cancers in conflict-affected regions such as Syria are severely limited. Our study aims to fill in significant gaps in data by evaluating the demographics of Syrian patients diagnosed with new GI malignancies over a three-year period. Methods: This is a retrospective epidemiological study conducted at Al-Bairouni University Hospital – Syria’s national cancer center serving 60-70% of the country’s cancer patients. We included all patients diagnosed with GI malignancies (esophagogastric [EG], hepatocellular [HCC], biliary tract [BTC], pancreatic [PC], colorectal [CRC] cancers, and others) between Jan 2022 - Dec 2024. Data extracted from hospital records included sex, age at diagnosis, cancer stage, smoking status, and governorate of residence. Patients were grouped by disease group and year to assess annual trends. Institutional ethical approval was obtained to perform the study. Results: A total of 3,493 patients were diagnosed with GI cancers during the study period: 1,220 in 2022, 905 in 2023, and 1,368 in 2024 (Table 1). Across all years, a consistent male predominance was observed (60.1%). The average age at diagnosis was 59 years, 37.8% of patients were smokers, and 48.3% of all cases had advanced/metastatic disease at diagnosis. CRC (1,779) and EG (830) were the most common GI cancers. The highest patient loads originated from Damascus (17.6%) and Rural Damascus (17.5%), followed by central governorates such as Homs (9.7%) and Hama (9.3%). Notably, patients from more distant and underserved governorates such as Deir ez-Zor (7.0%), Aleppo (6.58%), and Al-Hasakeh (6.79%) accounted for a significant proportion of the GI cancers presenting to our center. Conclusions: To our knowledge, this study provides the first comprehensive multi-year dataset of GI cancers in Syria, with representation from all 14 governorates in the country. More than a third of our cohort were smokers and nearly half were diagnosed with advanced disease, demonstrating a need for public heath efforts to tackle tobacco use and improve screening & early detection. This dataset offers a foundation for future public health planning and research efforts in the region. Demographics of GI cancers diagnosed 2022-2024. Diagnosis 2022 Cases 2023 Cases 2024 Cases Total Cases Average Age Male Sex (%) Smokers (%) Advanced/Metastatic at diagnosis EG 311 217 302 830 56.1 519 (62.5%) 379 (45.7%) 370 (44.6%) HCC 88 46 61 195 59.2 134 (68.7%) 82 (42.1%) 116 (59.5%) BTC 34 43 54 131 58.4 69(52.7%) 40 (30.5%) 79 (60.3%) PC 118 122 160 400 58.4 249 (62.3%) 180 (45%) 247 (61.8%) CRC 620 444 715 1779 57.6 1008 (56.7%) 582 (32.7%) 805 (45.2%) Others (anal, small intestine, unknown primary) 49 33 76 158 55.5 75 (47.5%) 59 (37.3%) 69 (43.7%)

809 Background: Barriers to necessary care can pose a significant burden on patients with cancer, even more so in places of conflict. Following a devastating 14-year war in Syria, there is limited data published on access to cancer care and the impact that barriers to management have on our patients. We surveyed patients presenting for cancer care to better understand the challenges they faced. Methods: This cross-sectional study included adult patients with a confirmed gastrointestinal (GI) cancer diagnosis presenting to Al-Bairouni University Hospital for care. Data was collected through face-to-face interviews using a structured questionnaire adapted for the Syrian context. The survey covered six key areas: Demographic & Clinical, Healthcare System Barriers, Financial Barriers, Geographic & Security Barriers, Reasons for Diagnostic Delays, and Psychosocial Impact. Multivariate analysis via logistic regression was conducted to determine which responses were associated with a higher odds ratio (OR) of having a late-stage (III/IV) cancer diagnosis. Results: A total of 122 patients diagnosed with a GI cancer were enrolled. The mean age was 57.4 years (±11.2 SD), with a male predominance (68%, n=83). Advanced diagnostics (CT/MRI/biopsy) and radiation therapy were inaccessible for 55% (n =67) and 61% (n =74) of patients, respectively. Systemic therapy drugs were "rarely" or "never" available for 35% (n=43) of patients, and 12% (n=15) reported waiting over three months for an appointment. The costs of medications "greatly" or "very greatly" impacted 88% (n=107) of patients. Over two-thirds of patients reported that essential pain control medications (e.g., morphine) were "rarely" or "never" available (68%, n=83). Nearly two-thirds (65%, n =79) reported that security concerns "greatly" or "somewhat" affected their ability to access treatment. An overwhelming 87% (n=106) of patients reported a negative psychological impact from their treatment course. Patient responses associated with a higher OR of late-stage cancer diagnosis are present in the table. Conclusions: Patients in Syria with GI cancers face profound systemic, financial, geographic, and psychosocial challenges throughout their care journey. More than half were diagnosed at advanced stages, with diagnostic delays strongly linked to prolonged waiting times and financial strain. Financial toxicity was highly evident, resulting in treatment compromise and asset liquidation. This data should serve as a reference for future public health and humanitarian efforts in the region. Factors associated with late-stage (III/IV) diagnosis of GI malignancies (multivariate logistic regression). Variable Adjusted Odds Ratio (aOR) 95% Confidence Interval p-value Waiting Time First Oncology appointment >1 month 3.10 1.45 - 6.62 0.003 * Unemployed due to cancer 2.85 1.20 - 6.78 0.018 * Sold Assets to Finance Care 2.40 1.10 - 5.25 0.028 * *Statistically significant at p < 0.05.