Abstract PS7-73: Late presentation and suboptimal treatment of breast cancer among Syrian refugees. A call for systematic international action
Authors: Abdel-Razeq Hikmat , Tamimi Faris , El-Atrash Maryam , Sharaf Baha' , Mansour Razan , Mustafa Rawan 
Published: February 2021

Abstract
Introduction: The Syrian crisis, started in 2011, has had a profound impact on the entire region. Jordan, a low-middle income country with limited resources is ranked first in the region in relation to the number of refugees hosted. The latest national census reported over a million Syrian refugee in the country. Lack of sufficient funding, from either the host country or international refugee aid organizations, may lead to suboptimal treatment of cancer patients. The total number of Syrian cancer patients registered at King Hussein Cancer Center (KHCC) hospital-based cancer registry was 510 patients. Local and regional funds covered the treatment of almost two thirds of these patients. In this study, we report on patterns of presentation and management of Syrian patients with breast cancer treated and followed at our institution. Patients and methods: This is a retrospective data collection of Syrian refugees who presented to our institution with a diagnosis of breast cancer from January 2011 to December 2019. Adult patients aged 18 year or older with pathologically-confirmed diagnosis of breast cancer were required to have at least one medical encounter. Data was collected from the electronic medical records for eligible patients. Management was compared against our approved clinical practice guidelines (CPG). Results: During the study period, a total of 147 adult Syrian refugee patients with breast cancer had at least one medical encounter at our institution. All were females and median age (range) at diagnosis was 47 (21-84) years. Thirty-four (23.1%) patients did not complete the work up and missed subsequent visits and will be excluded from analysis. The remaining 113 patient had biopsy proven invasive (n=110) or ductal carcinoma in situ (n=3) and continued their treatment and follow up; 39 (34.5%) had early stage disease, 48 (42.5%) locally advanced and 26 (23.0%) presented with metastatic disease. Estrogen receptors (ER) were positive in 75 (66.4%) patients while 63 (55.8%) had positive progesterone receptor (PR). HER2 positive disease was documented in 31 (27.4%) while 18 (15.9%) patients had triple negative disease. Eighty (70.8%) patients underwent surgery, 60 (75.0%) were at KHCC. The median time from first encounter to surgery for those who underwent upfront surgery was 2 months. Breast conserving surgery (BCS) was done for 27 (45.0%). However, only 11 (35.4%) of the 31 patients eligible for breast reconstruction underwent such procedure. Adjuvant radiation was given to 49 (77.7%) of 63 candidate patients and some were delayed. Systemic treatment with chemotherapy was given to 103 patients; as neoadjuvant (n=37, 35.9%), adjuvant (n=45, 43.7%) and palliative (n= 21, 20.4%). Among the 31 patients with HER2-positive disease, only 11 (35.5%) patients received it. Additionally, only 3 (30.0%) of 10 patients who were candidates for CDK4/6 inhibitors received it. Genetic Testing and counselling were also suboptimal, only 8 (12.3%) of 65 candidate patients underwent genetic testing. Across all needed treatment, 37 (32.7%) patients had significant deviations when judged against our institutional CPGs. Conclusions: Syrian refugees with breast cancer had late presentation and more advanced-stage disease. They are more likely to receive delayed and suboptimal surgeries, genetic counseling and systemic therapy highlighting the urgent need for international systematic approach for cancer care among such unprivileged population.
Citation Format: Hikmat Abdel-Razeq, Faris Tamimi, Maryam El-Atrash, Baha' Sharaf, Razan Mansour, Rawan Mustafa. Late presentation and suboptimal treatment of breast cancer among Syrian refugees. A call for systematic international action [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-73.