Abstract PS5-12-14: Between Hope and Hardship: Patient Perspectives on Treatment Cessation in Metastatic Breast Cancer in Syria

Abstract Background: Treatment decision-making in metastatic breast cancer (MBC) is complex. In low-resource and conflict-affected settings, studies rarely address the psychological burden and personal preferences of patients that shape MBC treatment decisions. In Syria, women face unique barriers, including financial hardship, limited access to modern therapies, and psychosocial strain. No prior studies have examined how Syrian women with MBC make treatment cessation decisions amid conflict-related healthcare disruptions. We aimed to characterize patient perspectives on pausing vs. continuing therapy in MBC within a conflict-affected, low-resource setting. Methods: We conducted a cross-sectional mixed-methods survey between August 2025 and September 2025 on Syrian MBC patients. Quantitative measures assessed sociodemographic and clinical factors, as well as Likert scale ratings of attitudes and illness impact. Qualitative responses were thematically analyzed and quantified to identify dominant concerns and support needs. Results: This study included 60 Syrian women with a confirmed diagnosis of MBC. Participants had a mean age of 48.2 years, most were married (75%), and were from low-income households (68.3%). Over 70% had lived with breast cancer 5 years. Hormonal therapy was the most common treatment (38.3%), while chemotherapy (5.0%), radiotherapy (8.3%), and immunotherapy/targeted agents (8.3%) were less accessible. Illness burden was high (Mean daily life impact score 6.9/10). Systemic barriers were striking: 40% reported incurring transport costs and financial burdens, and 17% noted a deterioration in medical services. 66.7% feared their cancer would progress if treatment were paused, and 75% cited treatment toxicity or cost as reasons to consider a break. 70% expressed a need for better psychological support and communication from physicians. Conclusion: Syrian women with MBC navigate the dual burden of treatment toxicity and collapse of the healthcare system, compounded by overlooked psychosocial needs. Most patients were unwilling to discontinue therapy despite hardships, a decision that might be influenced by the perception that access to treatment in Syria is a luxury and a privilege. Addressing psychological support, patient preferences, and equitable treatment access is essential to optimizing care in conflict-affected settings Citation Format: A. Kouli, A. Al-Bitar, L. Mardini, O. s. Almansour, Johar, M. Saifo, F. Kalam, M. Hafez. Between Hope and Hardship: Patient Perspectives on Treatment Cessation in Metastatic Breast Cancer in Syria abstract. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS5-12-14.