Cancer Care in Crisis: How Subsidy Cuts Affected Immunotherapy Access for Patients With Small Cell Lung Cancer in Lebanon

PURPOSE Lebanon's ongoing economic collapse has severely disrupted the health care system, particularly access to essential cancer therapies. Small cell lung cancer (SCLC) is an aggressive malignancy with limited treatment options and poor prognosis. Immune checkpoint inhibitors (ICIs) have provided modest survival benefits in extensive-stage SCLC (ES-SCLC), but access in resource-limited settings is highly vulnerable to financial instability. In October 2022, Lebanon officially withdrew public subsidies for ICIs, threatening equitable cancer care. This study evaluates the impact of the Ministry of Public Health subsidy withdrawal on access to ICIs and associated outcomes in patients with ES-SCLC. MATERIALS AND METHODS A mixed-methods study was conducted at Hôtel-Dieu de France (HDF) University Hospital in Beirut. The qualitative component involved a semi-structured interview with the HDF pharmacy to characterize operational challenges. The quantitative component was a retrospective cohort study of patients diagnosed with ES-SCLC from 2019 to 2024. Data included demographics, treatment access, and survival. Analyses included bivariate statistics, Kaplan-Meier survival analysis, and Cox proportional hazards regression. RESULTS The interview identified financial hardship and drug shortages as major barriers. Among 71 patients, 75% did not receive guideline-concordant optimal treatment. Access to ICIs was significantly associated with method of payment (χ 2 = 13.8, P = .037) and public insurance coverage (χ 2 = 8.6, P = .035). Survival was higher among patients receiving optimal treatment ( P = .021), male patients ( P = .004), and those treated before subsidy withdrawal ( P = .037). In multivariable Cox regression, male gender, optimal treatment, and public insurance were independently associated with improved survival. CONCLUSION The withdrawal of public subsidies amid Lebanon's economic crisis critically disrupted access to ICIs and contributed to poorer outcomes. Robust financial protection mechanisms are urgently needed to sustain equitable cancer care.