Comparative survival of cancer patients requiring Israeli permits to exit the Gaza Strip for health care: A retrospective cohort study from 2008 to 2017.

<h4>Background</h4>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...

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Autores principales:	Benjamin Bouquet, Francesco Barone-Adesi, Mohamed Lafi, Kathryn Quanstrom, Federica Riccardi, Henry Doctor, Walaa Shehada, Juliana Nassar, Sali Issawi, Mahmoud Daher, Gerald Rockenschaub, Arash Rashidian
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/35c42b17f44840e1ae1ff18fd3966d69
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spelling	oai:doaj.org-article:35c42b17f44840e1ae1ff18fd3966d692021-12-02T20:05:23ZComparative survival of cancer patients requiring Israeli permits to exit the Gaza Strip for health care: A retrospective cohort study from 2008 to 2017.1932-620310.1371/journal.pone.0251058https://doaj.org/article/35c42b17f44840e1ae1ff18fd3966d692021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0251058https://doaj.org/toc/1932-6203<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Findings</h4>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<0.001), after adjusting for age, sex, type of procedure, and type of cancer. There was no significant difference in mortality risk for the two groups in the 2008-2014 period.<h4>Interpretation</h4>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.Benjamin BouquetFrancesco Barone-AdesiMohamed LafiKathryn QuanstromFederica RiccardiHenry DoctorWalaa ShehadaJuliana NassarSali IssawiMahmoud DaherGerald RockenschaubArash RashidianPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 6, p e0251058 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Benjamin Bouquet Francesco Barone-Adesi Mohamed Lafi Kathryn Quanstrom Federica Riccardi Henry Doctor Walaa Shehada Juliana Nassar Sali Issawi Mahmoud Daher Gerald Rockenschaub Arash Rashidian Comparative survival of cancer patients requiring Israeli permits to exit the Gaza Strip for health care: A retrospective cohort study from 2008 to 2017.
description	<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Findings</h4>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<0.001), after adjusting for age, sex, type of procedure, and type of cancer. There was no significant difference in mortality risk for the two groups in the 2008-2014 period.<h4>Interpretation</h4>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.
format	article
author	Benjamin Bouquet Francesco Barone-Adesi Mohamed Lafi Kathryn Quanstrom Federica Riccardi Henry Doctor Walaa Shehada Juliana Nassar Sali Issawi Mahmoud Daher Gerald Rockenschaub Arash Rashidian
author_facet	Benjamin Bouquet Francesco Barone-Adesi Mohamed Lafi Kathryn Quanstrom Federica Riccardi Henry Doctor Walaa Shehada Juliana Nassar Sali Issawi Mahmoud Daher Gerald Rockenschaub Arash Rashidian
author_sort	Benjamin Bouquet
title	Comparative survival of cancer patients requiring Israeli permits to exit the Gaza Strip for health care: A retrospective cohort study from 2008 to 2017.
title_short	Comparative survival of cancer patients requiring Israeli permits to exit the Gaza Strip for health care: A retrospective cohort study from 2008 to 2017.
title_full	Comparative survival of cancer patients requiring Israeli permits to exit the Gaza Strip for health care: A retrospective cohort study from 2008 to 2017.
title_fullStr	Comparative survival of cancer patients requiring Israeli permits to exit the Gaza Strip for health care: A retrospective cohort study from 2008 to 2017.
title_full_unstemmed	Comparative survival of cancer patients requiring Israeli permits to exit the Gaza Strip for health care: A retrospective cohort study from 2008 to 2017.
title_sort	comparative survival of cancer patients requiring israeli permits to exit the gaza strip for health care: a retrospective cohort study from 2008 to 2017.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/35c42b17f44840e1ae1ff18fd3966d69
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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.

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