Dear Editor, The military hostilities between Iran and Israel in June 2025 have laid bare the acute fragility of cancer care systems within conflict zones. In periods of armed confrontation, medical resources are typically diverted toward trauma management and emergency response [1]; however, for oncology patients, the interruption of precise, time-sensitive regimens can prove as lethal as the conflict itself. Iran navigated this 12-day crisis with a healthcare infrastructure already significantly burdened by long-standing international sanctions, which had historically restricted the flow of diagnostic technology and essential pharmacological agents. This conflict forced a rapid, often improvisational transition in how oncological care is delivered, revealing both the resilience of the local medical workforce and the systemic vulnerabilities that demand urgent reform. During the height of the conflict, the perception of hospitals as potential targets—fueled by strikes on two medical facilities—created an environment of deep apprehension among both staff and patients. This fear, coupled with the withdrawal of several private sector oncology providers, placed an extraordinary burden on public institutions like the Cancer Institute of Iran. To sustain continuity, our facility underwent an immediate restructuring: radiotherapy shifts were condensed to mitigate risk, new patient admissions were paused to preserve capacity for those mid-cycle, and personnel were redeployed to ensure uninterrupted daily specialist coverage. Notably, the palliative care department successfully migrated to a remote consultative model, utilizing digital health platforms to maintain essential support services. While these measures were effective in the short term, they relied heavily on the personal sacrifices of staff who operated without formal crisis-management training, often requiring makeshift in-hospital accommodation to navigate the dangers of transit during air raids. The broader regional experience suggests that such challenges are far from unique. A comparative review of conflict zones reveals that oncology services frequently suffer from a “cascade effect” of failure. In Syria, persistent instability and the targeting of healthcare infrastructure led to the mass migration of oncology specialists and the fragmentation of treatment pathways [2]. Similarly, the Iraqi oncology experience over several decades highlights how systemic collapse, exacerbated by environmental hazards, forces patients into dangerous and costly reliance on international medical travel [3]. The Lebanese crisis, characterized by economic collapse and massive infrastructural damage, illustrates that a lack of financial liquidity can replicate the effects of open warfare, causing drug shortages and the breakdown of diagnostic capabilities [4]. Furthermore, prolonged blockades in the occupied Palestinian territory demonstrate that oncology mortality is often defined by restricted access to borders and essential materials, even in the absence of kinetic warfare [5]. Similar total-collapse scenarios in recent conflicts in Sudan and the Tigray region of Ethiopia further underscore the precarious nature of highly centralized urban oncology facilities [6,7]. These regional precedents clarify that ad-hoc adaptations are insufficient to protect oncology patients. We advocate for a “Dual-Resilience” framework that shifts the paradigm from emergency reaction to institutionalized preparedness. This model requires, first, the physical hardening of oncology infrastructure—specifically the reinforcement of radiotherapy bunkers housing radioactive sources and the development of localized, redundant power and water supplies. Second, it necessitates the creation of a “digital shield,” where electronic health records and imaging archives are backed up on secure, off-site servers, enabling treatment to continue seamlessly if the primary facility is compromised. Third, we must prioritize the psychological and logistical support of the oncology workforce, providing them with safe, hospital-based accommodations and mental health resources to ensure operational sustainability. Finally, oncology must be elevated as a protected category in international humanitarian law, with the establishment of monitored corridors specifically for the transport of chemotherapy agents, radioisotopes, and specialized diagnostic supplies. Ultimately, the 2025 Iran–Israel conflict serves as a sobering reminder that for the cancer patient, the “war” is constant. If we are to honor our ethical obligation to these vulnerable populations, the oncology community must integrate comprehensive disaster-preparedness protocols into the standard of care. By documenting these operational lessons and codifying them into international humanitarian standards, we can ensure that cancer care is prioritized—not as an afterthought, but as a critical component of civilian protection in the face of escalating global conflict.  

Introduction: Non-responsive or relapsed lymphoma patients may benefit from salvage chemotherapy or high-dose chemotherapy followed by autologous stem cell transplantation (ASCT), an effective treatment, particularly in non-Hodgkin's and Hodgkin's lymphoma. This study aimed to investigate recurrence in these patients and identify associated risk factors. Methods: A retrospective cohort study analyzed outcomes of lymphoma patients undergoing ASCT at Omid Hospital (2016-2020). Comprehensive data on demographics, treatment, underlying disease, recurrence, and pre-transplantation laboratory parameters were collected from hospital records. Follow-up from transplantation to February 2021 allowed for survival and recurrence evaluation using Kaplan-Meier and Cox regression. The study included patients without concurrent plasma cell disorders or other hematological malignancies for a focused lymphoma treatment outcome analysis. Results: Forty-nine lymphoma patients underwent ASCT (21 HL, 42.9%; 28 NHL, 57.1%). Gender distribution was similar (30 males, 61.2%; 19 females, 38.8%; P=0.774). Mean age at transplantation was 38.8 ± 11.15 years (P=0.519 between groups). Recurrence occurred in 14 patients (7 in each group; P=0.523), with a mean recurrence-free survival (RFS) of 25.2 months (95% CI: 21.44-28.96). HL patients had a lower mean RFS and a higher recurrence hazard ratio (HR: 1.25, 95% CI: 0.420-3.76), though not statistically significant (P=0.683). In NHL, older age significantly correlated with recurrence (P=0.030). While male gender and older age were associated with lower survival, only advanced age in NHL significantly predicted decreased survival (HR: 1.167, 95% CI: 1.102-1.197). Conclusions: Male HL patients showed diminished survival and an elevated hazard ratio (not statistically significant). Advanced age significantly predicted reduced survival in NHL patients. Pre-transplant laboratory markers did not significantly predict survival.

Pediatric cancers are a leading cause of death from non‑communicable diseases among children worldwide, with considerable regional variation in age‑standardized incidence and mortality rates. This study reviews the epidemiology of pediatric cancers in Iran in the context of global patterns, highlighting disparities in incidence, mortality, and survival outcomes. Incidence and mortality data were compared using the Iranian national cancer registry and GLOBOCAN 2020, while survival data were contrasted between the Iranian national study (IRANCANSURV) and the international CONCORD‑3 project. Globally, childhood cancer incidence ranges from 157 per million in very high‑income countries to 85 per million in low‑income regions. Iran reports an age-standardized incidence rate of 136 per million—one of the highest in the Eastern Mediterranean Region.The leading cancer types are leukemia (21 per million mortality) and brain/CNS tumors (15 per million). In Iran, the five‑year survival rate is approximately 68–70% for leukemia and 49% for CNS tumors, substantially below the > 90% and > 70% observed in high‑income settings. Survival also varies markedly across provinces—from 56.9% to 71.5% for leukemia and 16% to 57% for CNS cancers—reflecting disparities in healthcare access and data quality. Overall, although Iran exhibits relatively high childhood cancer incidence, outcomes remain limited by disparities in healthcare infrastructure, resource constraints, and incomplete registry coverage. These findings underscore substantial gaps in surveillance and emphasize the urgent need to strengthen pediatric oncology services, expand equitable access to specialized care, and enhance data collection to inform evidence‑based policy decisions.

Background: The increasing complexity of cancer care and rapid advancements indigital technologies have led to the emergence of smart cancer hospitals as innovativesolutions to contemporary healthcare challenges.Objective: This review aims to provide a comprehensive overview of the essentialarchitectural, technological, and operational requirements for designing and operatingsmart cancer hospitals.Methods: A synthesis of recent literature and global case studies was conducted toidentify core elements defining smart cancer hospitals, focusing on technology integration,adaptable architectural design, environmental considerations, IT infrastructure,and multidisciplinary care.Results: Smart cancer hospitals incorporate advanced technologies such as artificialintelligence, the Internet of Things (IoT), big data analytics, and telemedicineto enhance diagnostic accuracy, treatment efficiency, and patient experience. Modularand adaptable designs enable rapid technological updates and spatial flexibility.Sustainable architectural elements contribute to improved patient outcomes andstaff well-being. Robust IT infrastructure ensures secure, interoperable clinical dataexchange. Integration of multidisciplinary collaboration areas, palliative care, andpsychosocial support fosters holistic, patient-centered care.Conclusion: This review outlines critical components necessary for creating future-ready smart cancer hospitals that combine technological advancement withhuman-centered care. These insights aim to assist architects, healthcare providers,and policymakers in developing oncology facilities responsive to evolving cancer careneeds.

Modern medicine, despite its numerous benefits, often places oncologists in complex clinical scenarios. These situations require intricate choices to ensure patients receive optimal treatment. Advanced cancer patients, especially in borderline situations of expected benefit or increased risk of complications, face unique challenges.1 Overtreatment and undertreatment represent the two extremes of the therapeutic spectrum, both of which signify suboptimal management of cancer patients. These concepts vary significantly across different medical disciplines, healthcare providers, and patients, as there is no universally accepted definition.2 Oncologists undertake complex decision-making processes following detailed discussions with patients and their families, aiming to find the optimal balance in the therapeutic strategy. The question arises: Is it appropriate to recommend a new line of treatment for all cancer patients in the same manner, including elderly advanced cancer patients with comorbidities? As a palliative medicine specialist working in a government hospital in a developing country, when I consult with elderly advanced cancer patients who are resistant to the first-line available treatment, a primary concern for both patients and their relatives is whether to initiate a new, costly treatment with potentially unknown or limited efficacy, as recommended by the oncologist. From an ethical perspective, in some cases, the recommended treatment by oncologists may not be appropriate. This can be evaluated by considering the four fundamental principles of ethics: autonomy, beneficence, non-maleficence, and justice.