Delivering oncology care in Syria: Implementation lessons from conflict-affected and resource-limited settings.

Abstract

1607 Background: Oncology services are often excluded from humanitarian health response packages despite the rising cancer burden in conflict-affected populations. In northwest Syria, protracted conflict disrupted referral pathways, depleted the specialist workforce, and constrained diagnostic infrastructure. The Syrian American Medical Society (SAMS) implemented a conflict-adapted oncology model that evolved from remote specialty support (2017) to decentralized service delivery with phased diagnostic strengthening and workforce development. We report multi-year program outputs as indicators of implementation feasibility and scale. Methods: We conducted a retrospective program evaluation using routinely collected, aggregate operational indicators from SAMS-supported oncology services in northwest Syria (fixed sites with referral/outreach pathways). Annual indicators (2022–2025) included: total patients served, new patients, new malignant diagnoses, total oncology diagnoses (benign + malignant), and chemotherapy administrations. Longitudinal patient-level outcomes were not consistently captured due to displacement, insecurity, and lack of a unified electronic medical record during early scale-up. Results: Total patients served increased from 20,779 (2022) to 28,392 (2025) (+36.6%). New patients increased from 4,648 to 12,467 (+168.2%). New malignant diagnoses increased from 1,373 to 2,000 (+45.7%), and total oncology diagnoses increased from 15,102 to 21,918 (+45.1%). Chemotherapy administrations increased from 7,177 to 15,008 (+109.1%). Key implementation milestones included the establishment of the Idlib Cancer Center (2018), phased immunohistochemistry enabled through cross-border workflows and remote expert interpretation, and the institutionalization of local diagnostic capacity through a pathology residency launched around mid-2023, supported by hybrid local/remote mentorship and digital pathology infrastructure (slide scanning for remote review). A persistent system gap was the lack of local radiotherapy, requiring cross-border referral pathways that were vulnerable to administrative and access disruptions. Conclusions: A phased “minimum oncology service package” integrating decentralized delivery, tele-enabled expertise, and staged diagnostic/workforce strengthening can be implemented and scaled in protracted conflict settings. In the SAMS model, structured fellowship teaching, e-consultations, and a virtual breast tumor board supported timely decision making, while missions and workshops reinforced local capacity. This transferable framework supports integrating oncology into humanitarian responses, alongside investment in radiotherapy access and continuity-of-care data systems.