Nahhat, F.

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.