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.
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BACKGROUND: 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. METHODS: We conducted a retrospective cohort study of patients aged ≤21 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-Meier methods. RESULTS: A total of 169 patients were included; median age was 6.7 years (range, 0.01-21.3), and 62% were male. Median time from symptom onset to presentation was 3 months (range, 1-62). 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-E), 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, 72.1-87.7%) and 75.7% (95% CI, 64.6-83.7%), respectively; corresponding EFS estimates were 76.5% (95% CI, 67.0-83.6%) and 70.6% (95% CI, 59.4-79.3%). PICU-admitted patients had markedly lower 1-year OS (52.7% vs 86.8%; HR, 5.56; log-rank P<0.0001) and EFS (48.9% vs 81.8%; HR, 4.27; log-rank P<0.0001). CONCLUSIONS: 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.