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Comparative survival of cancer patients requiring Israeli permits to exit the Gaza Strip for health care: A retrospective cohort study from 2008 to 2017
- Source :
- PLoS ONE, Vol 16, Iss 6, p e0251058 (2021), PLoS ONE
- Publication Year :
- 2021
- Publisher :
- Public Library of Science (PLoS), 2021.
-
Abstract
- Background Gaza has been under land, sea, and aerial closure for 13 years, during which time Palestinian patients from Gaza have been required to obtain Israeli-issued permits to access health facilities in the West Bank (including east Jerusalem), as well as in Israel and Jordan. Specific groups, like cancer patients, have a high need for permits due to lack of services in Gaza. The approval rate for patient permits to exit Gaza dropped from 94% in 2012 to 54% in 2017. We aimed to assess the impact of access restrictions due to permit denials/delays on all-cause mortality for cancer patients from Gaza referred for chemotherapy and/or radiotherapy. Methods This study matched 17,072 permit applications for 3,816 cancer patients referred for chemotherapy and/or radiotherapy from 1 January 2008 to 31 December 2017 with referrals data for the same period and mortality data from 1 January 2008 to 30 June 2018. We carried out separate analyses by period of first application (2008–14; 2015–17), in light of varying access to Egypt during these times. Primary analysis compared survival of patients according to their first referral decision (approved versus denied/delayed) using Kaplan-Meier method and Cox regression. Findings Mortality in patients unsuccessful in permit applications from 2015–17 was significantly higher than mortality among successful patients, with a hazard ratio of 1·45 (95% CI: 1·19–1·78, p Interpretation Limitations to patient access due to unsuccessful applications for permits to exit the Gaza Strip had a significant impact on mortality for cancer patients applying for chemotherapy and/or radiotherapy in the period 2015–17. The substantially higher number of annual unsuccessful permit applications from 2015, combined with severely limited alternatives to access chemotherapy and radiotherapy during these years, may be important factors to explain the difference in the impact of permits delays/denials between the two study periods.
- Subjects :
- Male
Epidemiology
Cancer Treatment
Geographical Locations
Neoplasms
Health care
Breast Tumors
Medicine and Health Sciences
Israel
Multidisciplinary
Pharmaceutics
Mortality rate
Cancer Risk Factors
Hazard ratio
Middle Aged
Prognosis
Combined Modality Therapy
Survival Rate
Oncology
Medicine
Female
Egypt
Palestinian Territories
Research Article
Adult
Clinical Oncology
medicine.medical_specialty
Asia
Referral
Science
Radiation Therapy
Middle East
Cancer Chemotherapy
Drug Therapy
Breast Cancer
medicine
Humans
Chemotherapy
Survival rate
Retrospective Studies
Proportional hazards model
business.industry
Cancer
Cancers and Neoplasms
Retrospective cohort study
medicine.disease
Medical Risk Factors
Emergency medicine
People and Places
Africa
Health Facilities
Clinical Medicine
business
Delivery of Health Care
Licensure
Follow-Up Studies
Subjects
Details
- Language :
- English
- ISSN :
- 19326203
- Volume :
- 16
- Issue :
- 6
- Database :
- OpenAIRE
- Journal :
- PLoS ONE
- Accession number :
- edsair.doi.dedup.....cb9241dc67c12efd9f8d15b301746483