Assessing Willingness and Barriers to Clinical Trial Participation Among Patients With Cancer in Post-Conflict Syria: A Mixed-Methods Study.

PURPOSE: Syria's health care system has been severely damaged by conflict, leaving cancer care dependent on local hospitals with no global collaboration. This study assesses awareness, perceptions, and barriers to clinical trial participation among Syrian patients with cancer.

MATERIALS AND

METHODS

This mixed-methods cross-sectional study was conducted at Al-Bairouni University Hospital (March-August 2025). Quantitative data were collected via telephone interviews from 322 patients with cancer (78.3% response rate). Qualitative data came from 40 in-depth face-to-face interviews (purposive sampling to saturation). Multivariable logistic regression identified predictors of willingness to participate.

RESULTS

The mean age was 52.9 years (56.2% female). Nearly all participants (98.8%) had never heard of clinical trials. Willingness to participate was 37.0%, increasing to 61.5% if transportation and safety were guaranteed. Independent predictors were: having an information source (adjusted odds ratio [AOR], 5.42 [95% CI, 1.89 to 15.56]), religious/social traditions guiding refusal (AOR, 0.32 [95% CI, 0.18 to 0.57]), and palliative care only (AOR, 0.28 [95% CI, 0.11 to 0.71]). Qualitative themes revealed war-related health care devastation, fear of being lab rats, duality of hope and fear, primacy of personal trust in physicians, and insurmountable transportation costs.

CONCLUSION

Syrian patients with cancer face profound barriers to trial participation, including near-universal unawareness, fear of exploitation rooted in war trauma, and overwhelming economic obstacles. International partnerships incorporating transportation support and physician-led recruitment are essential for rebuilding research capacity.