The impact of socioeconomic crisis on cancer patient outcomes in Lebanon, 2018-2020.

Abstract

Aim: The goal of this study was to assess the impact of economic and social crisis on access to cancer care in Lebanon. Materials & methods: A cancer Drug Access Program in Lebanon was launched, covering 80-90% of treatment costs. The program included three drugs for breast cancer, renal cancer, and lung cancer. A longitudinal follow-up of patients was conducted. The Multidimensional Poverty Measure (MPI) was used by year (2019 or 2021), i.e., before and after the onset of the economic crisis. Results: A total of 613 cancer patients were included in 50 hospitals. Mean patient age was 58.5 years (standard deviation = 12.3). The proportion of cancer types was 79.3% breast, 10.6% renal, and 7.3% lung cancer. Treatment with palbociclib (hazard ration [HR]: 1.64; 95% confidence interval [CI]: 1.53-1.76, p < 0.0004), enrollment prior to 1 January 2019 (HR: 1.24; 95% CI: 1.07-1.44, p = 0.004), treatment at a hospital with fewer than five physicians (HR: 1.11; 95% CI: 1.00-1.23, p = 0.04), and lower 2019 MPI (HR: 1.69; 95% CI: 1.30-2.20) were significant predictive factors associated with survival. Higher governorate-level MPI was associated with increased mortality (adjusted rate ratio per 0.1-unit, HR: 2.88; 95% CI: 0.95-8.77, p = 0.06). Conclusion: Economic crises have negative impacts on health outcomes, and we identified a change in survival pre/post crisis onset. This study argues strongly for coordinated efforts to mitigate the negative effects of poverty on health.