Disease stage at diagnosis determines survival among Syrian refugee cancer patients treated at a metropolitan tertiary center in Türkiye

Abstract

Refugee populations experience major challenges in accessing cancer diagnosis and treatment, which frequently leads to delayed presentation and more advanced disease stages. However, there is still limited information on survival outcomes of refugee cancer patients receiving care in large metropolitan centers. This retrospective single-center cohort study included Syrian refugee cancer patients followed at a tertiary hospital in Istanbul, Türkiye. Demographic and clinical data were collected. Overall survival (OS) was estimated using the Kaplan-Meier method. Survival analyses were performed according to disease stage (stage I-II, III, IV), diagnosis timing in relation to migration (before vs. after migration), and treatment follow-up adherence. Survival differences were evaluated with log-rank tests. A total of 144 patients were analyzed, with a median age of 47.0 years. At the time of diagnosis, 41.7% of patients had localized disease (stage I-II), 20.8% had locally advanced disease (stage III), and 37.5% had metastatic disease (stage IV). The median follow-up for the overall cohort was 28.9 months. Median OS was not reached for the overall cohort. The 12- and 24-month OS rates were 95.1% and 85.0%, respectively. Overall survival differed significantly by disease stage (log-rank p < 0.001). Median OS was not reached in the stage I-II and stage III subgroups, whereas it was 51.0 months in the stage IV subgroup. The stage I-II subgroup demonstrated excellent short- and mid-term survival, with 12- and 24-month OS rates of 100% and 98.0%, respectively. In contrast, overall survival did not differ significantly according to diagnosis timing relative to migration (log-rank p = 0.51) or treatment follow-up adherence (log-rank p = 0.37). In Syrian refugee cancer patients treated at a metropolitan tertiary center, stage at diagnosis was the main factor associated with short- and mid-term survival. Diagnosis timing related to migration and treatment adherence were not significantly associated with OS in unadjusted analyses. These results emphasize the importance of early diagnosis and reducing late-stage presentation to improve cancer outcomes in refugee populations.