A population-based modelling study that aimed to project direct costs of cancer care among Syrian refugee populations residing in Jordan, Lebanon, and Turkey showed a substantial financial burden for host countries and humanitarian agencies, such as the UN Refugee Agency (UNHCR). New ways to provide financial support are needed, as well as clear prioritised pathways of care in this vulnerable population with cancer. The findings from the Research for Health in Conflict-Middle East and North Africa region (R4HC-MENA) collaborative study are published in May 2020 issue of The Lancet Oncology.
The study team led by Prof. Richard Sullivan of the Conflict and Health Research Group and Institute of Cancer Policy, King’s College London in London, UK wrote in the study background that no reliable data are available on the costs of cancer care for refugees. Such lack of data limits the planning of official support in humanitarian settings.
The authors emphasise that non-communicable diseases represent a substantial burden to refugee and host communities. However, traditionally humanitarian and refugee health response is focused on provision of healthcare services that address communicable diseases. The millions of refugees and internally displaced persons moving in and out of war zones through the Middle East, Asia, and Europe illustrate the need to rethink on health response and shift a focus to non-communicable diseases, among which cancer represents a challenge that requires a robust health system.
Growing prevalence of non-communicable diseases in low- and middle-income countries is characteristic of the epidemiological transition. The authors warn that cancer care remains neglected as a response to refugee health needs because of the financial costs involved and inadequate health service capacities.
This is the first study to estimate the cost of cancer treatment for Syrian refugees in Jordan, Lebanon, and Turkey. The study team estimated these costs using a model based on gross domestic product (GDP) and total national population size. They used different approaches to estimate costs, an approach that did not include the incidence of cancer in host countries (cost per capita), and two approaches that adjusted for cancer incidence and estimated costs per incident cancer case (either crude or age-standardised).
Cancer care costs for 4.74 million Syrian refugees in Jordan, Lebanon, and Turkey in 2017 were estimated to be 140.23 million EUR using the cost per capita approach, 79.02 million EUR using the age-standardised incidence approach, and 33.68 million EUR using the crude incidence approach. Under the lowest estimation, and with GDP and total country population as model predictors, the financial burden of cancer care was highest in Turkey (25.18 million EUR), followed by Lebanon (6.40 million EUR), and then Jordan (2.09 million EUR).
The authors concluded that their results provide an initial indication of the magnitude of the cancer burden among Syrian refugees and can inform the regional multi-stakeholder dialogue on coordinating action plans. Funding for cancer needs go beyond current UNHCR financing mechanisms. They point out that context-specific treatment protocols and guaranteed access and continuity of treatment will be crucial for improving cancer care models in conflict-affected regions.
The study was funded by the UK Research and Innovation Global Challenges Research Fund: R4HC-MENA.
Reference
Abdul-Khalek RA, Guo P, Sharp F, et al. The economic burden of cancer care for Syrian refugees: a population-based modelling study. Lancet Oncol 2020;21(5):637-644.