Saifo, Maher

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.

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.