{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T04:50:31Z","timestamp":1791521431008,"version":"4.3.4"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:00:00Z","timestamp":1791504000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Conflict-related displacement profoundly disrupts pediatric cancer care, yet clinical outcomes data for evacuated children treated at regional oncology centers remain scarce. We describe the clinical characteristics, diagnostic challenges, nutritional and psychosocial burden, and outcomes of children evacuated from Gaza and treated at King Hussein Cancer Center (KHCC), Jordan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study of patients aged \u226421 years evacuated from Gaza to KHCC between November 2023 and March 2026. Demographic and clinical characteristics, cancer type and stage, diagnostic concordance, nutritional and psychosocial status, and survival outcomes were assessed. Overall survival (OS) and event-free survival (EFS) were estimated using Kaplan\u2013Meier methods.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 169 patients were included; median age was 6.7 years (range, 0.01\u201321.3), and 62% were male. Median time from symptom onset to presentation was 3 months (range, 1\u201362). Among staged solid tumors, lymphomas, and brain tumors, 41.6% had distant disease at presentation. All patients with leukemia presented with systemic disease at diagnosis, and all patients with retinoblastoma presented with moderate-to-advanced intraocular disease (International Intraocular Retinoblastoma Classification Groups C\u2013E), with 83% classified as high-risk (Groups D\/E). Diagnostic discordance occurred in 19.5% of cases. Nutritional and psychosocial burden was substantial: 26.3% were underweight (44\/167 assessed), 50.3% had vitamin D deficiency (75\/149 assessed), and 41.4% reported clinically significant psychological distress. During a median follow-up of 8.0 months, 24 patients died (14.2%), including 2.4% who died within 30 days of presentation. One- and 2-year OS were 81.3% (95% CI, 72.1\u201387.7%) and 75.7% (95% CI, 64.6\u201383.7%), respectively; corresponding EFS estimates were 76.5% (95% CI, 67.0\u201383.6%) and 70.6% (95% CI, 59.4\u201379.3%). PICU-admitted patients had markedly lower 1-year OS (52.7% vs 86.8%; HR, 5.56; log-rank P&amp;lt;0.0001) and EFS (48.9% vs 81.8%; HR, 4.27; log-rank P&amp;lt;0.0001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Children evacuated from Gaza presented with advanced disease, diagnostic discordance, malnutrition, and substantial psychosocial burden, reflecting the clinical consequences of conflict-related disruption of healthcare. Despite these challenges, multidisciplinary care at a regional center of excellence achieves meaningful survival outcomes. These findings underscore the need for protected humanitarian evacuation pathways, integrated supportive care, and sustainable international funding for pediatric oncology services in conflict settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1934075","type":"journal-article","created":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T04:27:07Z","timestamp":1791520027000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["From armed-conflict to care: clinical outcomes, diagnostic challenges, and psychosocial burden in children evaluated for suspected cancer displaced from Gaza and treated at a regional center of excellence"],"prefix":"10.3389","volume":"16","author":[{"given":"Rawad","family":"Rihani","sequence":"first","affiliation":[{"name":"Department of Pediatrics, King Hussein Cancer Center (KHCC)","place":["Amman, Jordan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shrouq","family":"Amer","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, King Hussein Cancer Center (KHCC)","place":["Amman, Jordan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maha","family":"Barbar","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Nutrition, King Hussein Cancer Center (KHCC)","place":["Amman, Jordan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar","family":"Shamieh","sequence":"additional","affiliation":[{"name":"Department of Palliative Care, King Hussein Cancer Center (KHCC)","place":["Amman, Jordan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arwa","family":"Kiswani","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, King Hussein Cancer Center (KHCC)","place":["Amman, Jordan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Sullivan","sequence":"additional","affiliation":[{"name":"Institute of Cancer Policy, King\u2019s College London","place":["London, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Rodriguez-Galindo","sequence":"additional","affiliation":[{"name":"St Jude Children\u2019s Research Hospital","place":["Memphis, TN, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asem","family":"Mansour","sequence":"additional","affiliation":[{"name":"Chief Executive Office, King Hussein Cancer Center (KHCC)","place":["Amman, Jordan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,9]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(19)30273-6","article-title":"Global childhood cancer survival estimates and priority-setting: a simulation-based analysis","volume":"20","author":"Ward","year":"2019","journal-title":"Lancet Oncol"},{"key":"B2","unstructured":"Childhood Cancer"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(18)30761-7","article-title":"Childhood cancer burden: a review of global estimates","volume":"20","author":"Bhakta","year":"2019","journal-title":"Lancet Oncol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1537","DOI":"10.1186\/s12885-024-13256-9","article-title":"Cancer and Syria in conflict: a systematic review","volume":"24","author":"Basha","year":"2024","journal-title":"BMC Cancer"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(15)00223-5","article-title":"Global cancer surgery: delivering safe, affordable, and timely cancer surgery","volume":"16","author":"Sullivan","year":"2015","journal-title":"Lancet Oncol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pgph.0002530","article-title":"Towards attainment of the 2030 goal for childhood cancer survival for the World Health Organization Global Initiative for Childhood Cancer: An ecological, cross-sectional study","volume":"4","author":"Smith","year":"2024","journal-title":"PloS Glob Public Health"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(20)30022-X","article-title":"Sustainable care for children with cancer: a Lancet Oncology Commission","volume":"21","author":"Atun","year":"2020","journal-title":"Lancet Oncol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(24)00559-X","article-title":"The impact of armed conflict on global patterns of childhood cancer","volume":"26","author":"Espinoza","year":"2025","journal-title":"Lancet Oncol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(21)00655-0","article-title":"Cancer care for children in the Gaza Strip","volume":"22","author":"Salman","year":"2021","journal-title":"Lancet Oncol"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(26)00064-1","article-title":"Reopening the humanitarian corridor from Gaza to the West Bank and East Jerusalem for medical evacuations","volume":"14","author":"Feldon","year":"2026","journal-title":"Lancet Glob Health"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.26719\/2025.31.4.243","article-title":"Restoring health and hope to displaced Gaza children with malignant disease at a cancer centre in Jordan","volume":"31","author":"Rihani","year":"2025","journal-title":"East Mediterr Health J Rev Sante Mediterr Orient Al-Majallah Al-Sihhiyah Li-Sharq Al-Mutawassit"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2024-015493","article-title":"Challenges of access to care for children with cancer living in the Gaza Strip\/occupied Palestinian territory in 2022: a cross-sectional study","volume":"11","author":"Massad","year":"2026","journal-title":"BMJ Glob Health"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2023.1112788","article-title":"The burden and scope of childhood cancer in displaced patients in Jordan: The King Hussein Cancer Center and Foundation Experience","volume":"13","author":"Rihani","year":"2023","journal-title":"Front Oncol"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.26719\/2025.31.4.235","article-title":"Psychosocial experiences of refugee Gaza children who received cancer treatment in Jordan","volume":"31","author":"Shamieh","year":"2025","journal-title":"East Mediterr Health J Rev Sante Mediterr Orient Al-Majallah Al-Sihhiyah Li-Sharq Al-Mutawassit"},{"key":"B15","doi-asserted-by":"publisher","first-page":"146","DOI":"10.1186\/s13034-024-00840-x","article-title":"Mental health needs in war-affected refugee children: barriers, gaps, and strategies for effective care","volume":"18","author":"Khosravi","year":"2024","journal-title":"Child Adolesc Psychiatry Ment Health"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.20910","article-title":"International Classification of Childhood Cancer, third edition","volume":"103","author":"Steliarova-Foucher","year":"2005","journal-title":"Cancer"},{"key":"B17","unstructured":"Summary Staging Manual 2000 - Seer"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1188\/17.ONF.329-336","article-title":"NCCN distress thermometer: cut off points and clinical utility","volume":"44","author":"Cutillo","year":"2017","journal-title":"Oncol Nurs Forum"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2023.970164","article-title":"A distress thermometer with a cutoff score of \u2265 6 is the optimal point to identify highly distressed patients with advanced cancer stages in resource-limited countries without palliative care services","volume":"13","author":"Abu-Odah","year":"2023","journal-title":"Front Oncol"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2025.103463","article-title":"Disparities in pediatric oncology access and outcomes in the occupied Palestinian territories: a retrospective study from Augusta Victoria Hospital","volume":"88","author":"Rimawi","year":"2025","journal-title":"EClinicalMedicine"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)30458-6","article-title":"Access to pathology and laboratory medicine services: a crucial gap","volume":"391","author":"Wilson","year":"2018","journal-title":"Lancet Lond Engl"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2024.1328374","article-title":"Pediatric neuropathology practice in a low- and middle-income country: capacity building through institutional twinning","volume":"14","author":"Gilani","year":"2024","journal-title":"Front Oncol"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1097\/MPH.0000000000000688","article-title":"Patterns of diagnosis and misdiagnosis in pediatric cancer and relationship to survival","volume":"39","author":"Chen","year":"2017","journal-title":"J Pediatr Hematol Oncol"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-4642(19)30407-9","article-title":"Nutrition during childhood cancer treatment: current understanding and a path for future research","volume":"4","author":"Joffe","year":"2020","journal-title":"Lancet Child Adolesc Health"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.28213","article-title":"The relevance of nutrition to pediatric oncology: A cancer control perspective","volume":"67","author":"Rogers","year":"2020","journal-title":"Pediatr Blood Cancer"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1016\/j.jped.2014.11.009","article-title":"Infection with multidrug-resistant gram-negative bacteria in a pediatric oncology intensive care unit: risk factors and outcomes","volume":"91","author":"Costa","year":"2015","journal-title":"J Pediatr (Rio J)"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.5005\/jp-journals-10071-23693","article-title":"Critically ill pediatric oncology patients: what the intensivist needs to know","volume":"24","author":"Al Haj Moussa","year":"2020","journal-title":"Pediatr Crit Care Med Indian J Crit Care Med Peer-Rev Off Publ Indian Soc Crit Care Med"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1097\/MPH.0000000000002926","article-title":"Understanding diagnosis delay in children with cancer: evidence from a single institution in jordan","volume":"46","author":"Al-Nassan","year":"2024","journal-title":"J Pediatr Hematol Oncol"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.4274\/tjh.2016.0046","article-title":"Varicella-zoster virus infections in pediatric malignancy patients: A seven-year analysis","volume":"33","author":"D\u00fczg\u00f6l","year":"2016","journal-title":"Turk J Haematol Off J Turk Soc Haematol"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2023.1120990","article-title":"Concerns and priority outcomes for children with advanced cancer and their families in the Middle East: A cross-national qualitative study","volume":"13","author":"Boufkhed","year":"2023","journal-title":"Front Oncol"},{"key":"B31","doi-asserted-by":"publisher","first-page":"932","DOI":"10.1186\/s12889-021-10921-7","article-title":"Protocol for a caregiver psychosocial support intervention for populations affected by displacement in Uganda","volume":"21","author":"Cohen","year":"2021","journal-title":"BMC Public Health"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1934075\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T04:27:08Z","timestamp":1791520028000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1934075\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,9]]},"references-count":31,"alternative-id":["10.3389\/fonc.2026.1934075"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2026.1934075","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,9]]},"article-number":"1934075"}}