Coping of patients with hematological malignancies with the Iron Swords war: The mixed- method analysis of an Israeli national survey

Coping of patients with hematological malignancies with the Iron Swords war: The mixed- method analysis of an Israeli national survey | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Coping of patients with hematological malignancies with the Iron Swords war: The mixed- method analysis of an Israeli national survey Ilana Levy Yurkovski, Giora Sharf, Varda Shoam, Tamar Tadmor This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8005031/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 9 You are reading this latest preprint version Abstract Background Patients with hematological malignancies are vulnerable to psychological distress in times of crisis. We evaluated emotional burden, coping, and care continuity during the Iron Swords war in Israel and compared findings to a prior COVID-19 survey. Methods A national cross-sectional survey was conducted in September 2025 among Hebrew-speaking patients with hematological malignancies. Data included sociodemographic and clinical items, disease management, fears (Likert scales), the Patient Health Questionnaire-9 (PHQ-9), and three open-ended questions analyzed thematically. Results were compared with a similar 2021 COVID-19 survey. Results Of 836 patients approached, 188 responded (22%). War affected many patients: 45% had a relative recruited to the army, and 2% reported evacuation or a family member injured/killed. Treatment disruptions were limited (5% delays, 5% alternative therapy, one deferred CAR-T). Depression was frequent (mean PHQ-9 was 10.4 ± 5.6), with 49% in moderate-to-severe ranges, significantly higher than during COVID-19 (9.2 ± 5.9, p = 0.022). Female sex and the wartime period independently predicted depression severity. Anxiety regarding clinic safety was generally low but higher in women, older and lymphoproliferative patients. Thematic analysis revealed fear/anger about war and government (38%) as the most common difficulty, while family support (23%) was the main coping resource. Conclusions Compared to the COVID-19 pandemic, the Iron Swords war was associated with greater psychological distress despite fewer care disruptions. Hematology services should incorporate systematic screening and psychosocial support to safeguard patient well-being during crises. Hematological malignancies Iron Swords war Survey Coping Depression Mixed-methods Figures Figure 1 INTRODUCTION The Iron Swords war, which erupted on October 7, 2023, profoundly disrupted daily life in Israel and reshaped the experience of both citizens and patients with chronic diseases ( 1 ). Beyond the immediate physical threat, the persistent reality of air-raid sirens, repeated rushes to shelters several times a day, and the uncertainty of when and where the next attack might occur became part of the daily routine. During this period, the prevalence of probable post-traumatic stress disorder (PTSD) and depression nearly doubled in the Israeli population, with direct exposure to the attack contributing significantly to these findings ( 1 ). Many communities were evacuated, while numerous hospitals and outpatient clinics were repeatedly relocated between protected areas and regular wards to ensure continuity of care. Health personnel often juggled their clinical duties while coping with the mobilization or loss of family members. Nearly every family was personally affected, whether through a relative serving in the reserves, being displaced, or among the kidnapped. Prior to the war, the emotional burden of chronic illness, including depression, had been studied in various patient populations. Among patients with hematological malignancies, depression was reported in approximately 54% of cases in a Greek study and was associated with reduced quality-of-life (QoL) and impaired cognitive functioning ( 2 ). Suicide attempts have also been shown to be prevalent among cancer patients in general, and particularly among those with hematological malignancies ( 3 ). In Israel, a survey conducted during the COVID-19 pandemic demonstrated that 42% of patients with haemato-oncological diseases suffered from at least moderate depression, with higher rates observed among patients with chronic myeloid leukemia, while main ways to cope with difficulties in this period included family or friends and staying busy ( 4 ). More recently, a study found that psychological distress in the general Israeli population was more severe during the Iron Swords war compared to the COVID-19 pandemic. This distress was strongly and negatively correlated with both hope and sense of coherence ( 5 ). Against this backdrop, the aim of the present study was to evaluate demographic and clinical factors associated with emotional distress in patients with hematological malignancies during the Iron Swords war in Israel, and to compare selected findings with data previously reported from a similar survey conducted during the COVID-19 pandemic in Israel ( 4 ). METHODS Study design : This was a cross-sectional survey conducted among patients with hematological malignancies during the Iron Swords war in Israel, approximately two years after the onset of the conflict. The study was reviewed and approved by the Institutional Review Board of Bnai Zion Medical Center in accordance with the declaration of Helsinki (approval number BNZ-25-0083). Data was collected in September 2025. The survey was distributed via Google Forms platform and disseminated through social networks, email, telephone, and patient-organization chat groups (Halil Haor, AMEN). Four reminders to fill in the survey in Hebrew were sent in these platforms during the study period. Participants : Eligible participants were Hebrew-speaking adults (age 18 years and older) with hematological malignancies. Formal written consent was not required because the survey was anonymous. Before completing the questionnaire, participants were informed that the collected data would be used exclusively for statistical analyses and research purposes. Questionnaires : The questionnaire was adapted from a previously reported survey during the COVID-19 pandemic ( 4 ). It included 13 socio-demographic and medical baseline items, 10 questions concerning the management of hematological disease during the Iron Swords war, and 4 questions regarding social and emotional aspects during the war, including degree of involvement (e.g., relatives injured, murdered, or serving in the army). In addition, 2 questions assessed fears during the war on a 1–7 Likert scale. Participants also completed the Patient Health Questionnaire-9 (PHQ-9), a validated instrument for assessing depression severity and its impact on daily functioning, with a validated Hebrew translation ( 6 ). PHQ-9 total scores (range 0–27) categorize depression as none/minimal (0–4), mild ( 5 – 9 ), moderate ( 10 – 14 ), moderately severe (15–19), or severe (20–27). Finally, participants answered three open-ended questions addressing perceived difficulties, supportive resources, and suggestions to alleviate current challenges. Quantitative and qualitative analyses were conducted using a mixed-methods approach. Statistical analysis : Descriptive statistics were calculated for all demographic and clinical variables. Continuous variables were expressed as mean ± standard deviation (SD) and median with interquartile range (IQR), while categorical variables were expressed as proportions. Comparisons between the Iron Swords and COVID-19 surveys were performed using the t-test for normally distributed continuous variables, and the independent Chi-square test or Fisher’s exact test for categorical variables. Multivariate logistic regression analysis was performed to adjust for sociodemographic and clinical covariates influencing PHQ-9 depression categories. Odds ratios (ORs) with 95% confidence intervals (CIs) were reported, with p < 0.05 considered statistically significant. In addition, multivariate Poisson regression was applied to account for covariates influencing Likert-scale survey responses. Adjusted unstandardized regression coefficients (β) with 95% CIs were reported, with p < 0.05 considered statistically significant. Statistical analyses were conducted using IBM SPSS Statistics version 22. Thematic analysis : Responses to open-ended questions were analyzed using thematic analysis, a qualitative approach that identifies recurring themes or concepts in text ( 7 – 9 ). The procedure involved open coding, category creation, and abstraction ( 10 ). Codes were generated through inductive analysis, a method applied when prior research on the phenomenon is lacking or only fragmentary ( 11 ). RESULTS Baseline characteristics : Of the 836 patients approached, 188 completed the survey (response rate: 22%). Among respondents, 83 (44%) had multiple myeloma (MM), 53 (28%) a lymphoproliferative disease (LPD), 22 (12%) a myelodysplastic or myeloproliferative neoplasm (MDS/MPN), 17 (9%) acute leukemia, and 13 (7%) chronic myeloid leukemia (CML). Baseline characteristics are summarized in Table 1 . Table 1 Baseline characteristics Baseline characteristics Descriptive Age (years)* 65 ± 13 Time from diagnosis (years)* 7,3 ± 9.5 Sex Male – N (%) 76 (40%) Familial status Married / in couple – N (%) 145 (77%) Divorced – N (%) 22 (12%) Single – N (%) 8 (4%) Widow – N (%) 13 (7%) Number of children 3 ± 1 I live With family – N (%) 155 (82%) Alone – N (%) 31 (16%) Nursing help – N (%) 2 (1%) Religion Jewish – N (%) 182 (97%) Other – N (%) 6 (3%) Country of birth Israel – N (%) 147 (78%) Europe – N (%) 20 (11%) Former USSR – N (%) 6 (3%) America – N (%) 7 (4%) North Africa – N (%) 8 (4%) Education Academic – N (%) 131 (70%) Professional – N (%) 27 (14%) Finished high-school – N (%) 26 (14%) Did not finish high-school – N (%) 4 (4%) Occupation Retiree – N (%) 101 (54%) Salaried – N (%) 51 (27%) Independent – N (%) 18 (10%) Do not work (Housewife, unemployed, loss of capacity) – N (%) 18 (10%) Hematological disease Multiple Myeloma – N (%) 83 (44%) Lymphoproliferative disease – N (%) 53 (28%) Myelodysplastic or Myeloproliferative – N (%) 22 (12%) Acute leukemia – N (%) 17 (9%) Chronic myeloid leukemia – N (%) 13 (7%) Region of Hematological Follow-up Center of Israel – N (%) 116 (62%) Northern Israel – N (%) 39 (21%) Southern Israel – N (%) 13 (7%) Jerusalem region – N (%) 20 (11%) Treatment for hematological disease No treatment – N (%) 61 (32%) Oral only – N (%) 57 (30%) Intravenous and/or subcutaneous – N (%) 70 (37%) * Mean ± Standard deviation Legend : USSR: Union of Soviet Socialist Republics. Management of hematological malignancy during Iron Swords war : During the war, most patients arrived at the hematology clinic either by private vehicle or on foot (60%), while 21% were accompanied by family members. Regarding home safety, 83% reported having access to a shelter within their building, 11% needed to leave the building for a nearby shelter, and 5% had no shelter available. A considerable proportion of patients were directly affected by the war: 84 (45%) had relatives serving in the army, 3 (2%) were evacuated, and 3 (2%) had a relative who was injured or killed. Despite these circumstances, treatment disruptions were limited: 10 patients (5%) experienced delays, 9 (5%) received an alternative treatment, and only in one patient (0.5%) CAR-T cell therapy was deferred during the war (Table 2 ). When asked to compare the quality of clinic visits during the war to the pre-war period, using a 1–4 scale (1 = significantly worse, 4 = slightly better), the median score was 3 [IQR 2–3]. Table 2 Hematological management during Iron Swords’ war Hematological management N (%) During Iron Swords’ war I come to hematological visits Personal vehicle or walking 113 (60%) Public transport 30 (16%) Taxi 5 (3%) Accompanied by family 40 (21%) I have in my home Safe room 121 (64%) Shelter in building 36 (19%) Nearby shelter 21 (11%) No shelter 10 (5%) I was evacuated from my home following the war 3 (2%) At least one relative was recruited to the army since the beginning of the war 84 (45%) At least one relative was hurt or murdered during the war 3 (2%) I was supposed to receive treatment but it was delayed because of the war 10 (5%) If yes, delayed by 1 month 1 (10%) Treatment delay was In my demand 4 (40%) Physician decision 6 (60%) I was supposed to receive CAR-T but it was delayed because of the war 1 (0.5%) I received an alternative treatment for my hematological disease due to the war 9 (5%) Patients’ fears during the Iron Swords war : Patients evaluated their fears on a 7-point Likert scale (1 = almost never, 7 = almost always). For the statement “I am anxious about national security and the war in relation to my hematology clinic,” the mean score was 1.9 ± 1.4, with a median of 1 [IQR 1–2]. Multivariate Poisson regression revealed that female sex (β = 1.6 [1.1–2.4], p = 0.021) and LPD diagnosis (β = 2.2 [1.1–4.5], p = 0.026) were independently associated with higher anxiety scores, whereas younger age was associated with lower scores (β = 0.96 [0.95–0.98], p < 0.001). For the statement “The hospital responds to my needs regarding anxiety related to the Iron Swords war” (1 = not at all, 7 = very much), the mean score was 5.2 ± 1.8, with a median of 6 [IQR 4–7]. No demographic or clinical factors were associated with these responses. Depression according to PHQ-9 questionnaire : The mean PHQ-9 score was 10.4 ± 5.6, with a median of 9 [IQR 6–14]. Among respondents, 26 (14%) had no or minimal depression, 70 (37%) mild depression, 48 (25%) moderate depression, 28 (15%) moderately severe depression, and 16 (9%) severe depression. Compared with data from the COVID-19 survey, patients during the war reported significantly higher PHQ-9 scores (10.4 ± 5.6 vs. 9.2 ± 5.9, p = 0.022) and a more severe distribution across PHQ-9 categories (p = 0.013; Fig. 1 ). Multivariate logistic regression showed that depression severity was associated only with the wartime (vs. COVID-19) period (OR 1.9 [1.4–2.8], p < 0.001) and female sex (OR 1.6 [1.1–2.1], p = 0.007). Open-ended questions : Thematic analysis revealed that the main difficulties patients faced during the Iron Swords war were fear and anger related to the war and government, reported by 71 patients (38%), physical symptoms attributable to the disease or its treatment, reported by 46 patients (25%), and anxiety related specifically to their hematological condition, described by 23 patients (12%), while 39 (21%) did not describe any fear or anxiety. These concerns did not differ significantly across disease subgroups (p = 0.21). When asked about coping mechanisms, patients most often cited support from family or friends (43 patients, 23%). Others mentioned relying on personal resources, art, or religion (16 patients, 8.5%), engaging in physical exercise (15 patients, 8%), turning to complementary medicine (14 patients, 7%), or remaining occupied through work and daily activities (12 patients, 6%). Fifty-nine patients (31%) did not mention any coping mechanism. As for potential solutions that might alleviate these difficulties, patients most frequently pointed to political or governmental change and resolution of war-related issues (40 patients, 21%). Additional suggestions included psychological support or opportunities for discussion with peers (24 patients, 13%), increased social and family activities (21 patients, 11%), and the positive influence of health improvements or favorable medical outcomes (12 patients, 6%). Finally, 78 (42%) patients did not mention any potential solution. Quotations and keywords of the thematic analysis are presented in Table 3 . Table 3 Thematic analysis of open-ended questions Themes Frequency – N (%) Quotations Keywords (mentions) 1st question: Burdens/difficulties patients were dealing with during the Iron Swords war* Fear and anger related to the war and government 71 (38%) “Uncertainty on war and kidnapped people” “Hopelessness, dismantled country” “Complete frustration about what happens in the country” “Anger about the situation and hopelessness that it may change” “Kidnapped” ( 15 ) “War” ( 6 ) “Government” ( 5 ) “Reservists” ( 4 ) Physical manifestations related to the hematological condition or its treatment 46 (25%) “Decreased cognitive status” “Pain in the left hand” “Fatigue, lack of desire to do anything” “Pneumonitis following Bleomycin treatment” “Fatigue” ( 12 ) “Pain” ( 10 ) “Insomnia” ( 6 ) Fears related to the hematological disease 23 (12%) “Active disease” “Uncertainty about the disease” “Health state” “Neurological dysfunction due to the disease” “That the disease progresses” “Disease” ( 7 ) “Treatment” ( 6 ) No difficulty or no answer 39 (21%) 2nd question: Main ways to cope with the mentioned difficulties** Family or friends 43 (23%) “Familial support” “Relationship with other people and routine” “Meeting with family, friends, hiking” “Family” (25) “Friends” (20) “Children” ( 5 ) Personal resources (optimism, faith, art) 16 (8.5%) “Mobilizing internal resources and disconnect from the news” “Music, podcasts, personal and spiritual empowerment with faith” “Music” ( 5 ) “Prayer” ( 3 ) “Serenity” ( 3 ) “Hope” ( 2 ) Physical exercise 15 (8%) “Walking” “Physical effort” “Sport” ( 9 ) “Activity” ( 4 ) Complementary medicine 14 (7%) “Psychological support and complementary medicine” “Mindfulness and mind-body therapy” “Mindfulness” ( 3 ) “Meditation” ( 3 ) “Complementary” ( 2 ) Being occupied 12 (6%) “Being part of the manifestations” “Going to work and staying occupied” “Some learning, some agriculture, gardening” "Work" ( 6 ) "Occupy" ( 3 ) No way to cope to difficulties 59 (31%) 3rd question: Main solutions that may have helped improving the mentioned difficulties*** Government change and war issues 40 (21%) “Change of the government” “Coming back of the kidnapped people” “Ending of the war” “War” ( 13 ) “Kidnapped” ( 11 ) “Government” ( 9 ) Conversation with patients or psychologist 24 (13%) “To talk about the situation with other patients” “More emotional support in the hospital” “Conversation with professional psychologist” “Conversation” ( 7 ) “Support” ( 5 ) “Psychologist” ( 4 ) Familial and social activities 21 (11%) “Relationship with other people, going out to movies” “More familial meetings” “Friends” ( 7 ) “Meeting” ( 6 ) “Family” ( 3 ) Health, normal medical results 12 (6%) “To be cured from this disease” “Success of this treatment” “Treatment” ( 7 ) “Disease” ( 3 ) No potential solution 78 (42%) * Other difficulties mentioned: Loneliness, Fear related to work or economic issues. ** Other ways to cope with the mentioned difficulties: Substance use (drugs or cannabis), Rest, Hematologist's support, Technology (e.g. internet, telephone) *** Other potential solutions: Economic support, Physiotherapy, Better consideration from the system and the physicians, Rest and vacations, Substance use (drugs, cannabis) DISCUSSION In this national survey conducted approximately two years into the Iron Swords war, we observed a high burden of depression among patients with hematological malignancies, despite minimal disruption to disease management. Anxiety specifically related to the security situation or to attending hematology clinics was generally low but more pronounced among women, older patients, and those with LPD. Importantly, patients rated institutional responsiveness favorably, suggesting that hematology services largely maintained accessibility and support during wartime. Qualitative findings revealed that fear and anger concerning the war and government (38%) were the dominant emotional burdens, while one-third of respondents reported no clear coping strategy (31%). Clinical implications: When compared with our earlier national survey conducted during the COVID-19 pandemic ( 4 ), notable contrasts emerge. The pandemic period was marked by widespread logistical barriers (37% reduced clinic attendance and 9% treatment delays) together with emotional distress dominated by isolation and loneliness. In contrast, the Iron Swords war was associated with fewer disruptions in care but significantly higher depression severity. These patterns are consistent with findings from population-based research showing greater psychological distress in the general Israeli population during the Iron Swords war compared with the COVID-19 period ( 5 ). The war’s ongoing and tangible threat, coupled with political instability and collective trauma, may provoke a deeper sense of helplessness and anger than the abstract biological threat of a pandemic. Together, these findings suggest that during wartime, external threat and societal stressors—not service interruption—are the primary drivers of psychological distress, whereas the pandemic’s impact was more related to isolation, contagion fear, and altered care routines. Our study focused specifically on patients with hematological malignancies, a cohort known to experience higher baseline levels of anxiety and depression than the general population ( 12 ). In contrast to our COVID-19 survey, in which CML was associated with the most severe depression, diagnosis was not an independent predictor of depressive severity during the Iron Swords war. However, LPD patients exhibited greater anxiety regarding their hematologic care. This likely reflects their need for frequent in-person visits for parenteral therapy, which could not be deferred or shifted to telemedicine. As recent oncology studies demonstrate, telehealth can effectively maintain treatment continuity even during crises, providing high patient satisfaction ( 13 ), fewer acute complications ( 14 ), and even potential integration for parenteral therapy delivery including among lymphoma patients ( 15 ). Expanding telehealth options, especially for LPD patients, should therefore be a priority for hematology services during times of conflict. Our findings also parallel population-level data showing surges in PTSD, anxiety, and depression during Iron Swords, with distress strongly correlated with diminished hope and sense of coherence ( 5 ). This convergence reinforces the idea that ambient war-related stressors—such as displacement, family mobilization, or exposure to media coverage—can overwhelm coping resources even when medical services remain operational. Thus, the locus of distress among hematology patients extends beyond disease-related concerns to encompass broader existential and societal dimensions. Women were again identified as particularly vulnerable, with female gender independently associated with both higher war-related anxiety and more severe PHQ-9 depression scores. This aligns with previous research showing that women tend to exhibit greater psychological morbidity following traumatic or prolonged crises, including the Iron Swords war itself ( 16 ). Conversely, the finding that younger patients reported lower anxiety regarding hematology care contrasts with prior studies where younger age was linked to higher distress ( 17 ). One possible explanation is that older patients—who may face reduced mobility, greater dependence, and heightened mortality awareness—experienced stronger insecurity about clinic access and safety, whereas younger individuals may have demonstrated greater adaptability or resilience. As in 2021, family and friends remained the predominant coping resource, underscoring the protective role of close social bonds. Yet, the higher proportion of patients reporting no coping strategy (31%) and frequent calls for political resolution or systemic change reveal distress driven by macro-level uncertainty rather than medical circumstances. Nevertheless, requests for psychological support (13%) and social re-engagement (11%) highlight tangible opportunities for hematology clinics to collaborate with psycho-oncology and community-based services to provide emotional support, peer dialogue, and structured resilience interventions. Another coping mechanism underlined by 7% of patients was complementary and integrative medicine which may offer additional avenues for relief. Indeed, recent evidence from an Israeli randomized integrative oncology study demonstrated that manual-relaxation therapy with or without acupuncture produced immediate and meaningful reductions in emotional distress and anxiety, and improved pain control and overall wellbeing among cancer patients during Iron Swords war ( 18 ). Such integrative oncology programs can create a therapeutic “safe space,” enhancing calmness and resilience even amid conflict. Embedding these approaches alongside psychosocial screening and support within hematology clinics may therefore represent an effective, patient-centered strategy to mitigate depression and anxiety during crises. Taken together, our results underscore the need to adapt hematology practice in conflict settings. Maintaining continuity of care even through telehealth is critical, not only for medical outcomes but also for psychological security. Clear communication about safety, accessibility, and contingency planning can mitigate anxiety. Incorporating routine mental-health screening (e.g., PHQ-9 and brief PTSD assessments) into clinical visits may enable early identification of vulnerable patients. In parallel, hematology departments should integrate psychosocial and integrative services, including access to psychologists, virtual or in-person support groups, and evidence-based complementary modalities that enhance patients’ sense of coherence and control. Strengths and limitations The study’s strengths include replication of a validated national survey instrument enabling direct comparison across crises, and its mixed-methods design providing both quantitative and qualitative insights. Limitations include its cross-sectional design, potential selection bias favoring digitally connected patients, the large majority of Jewish patients (probably related to the Hebrew-only version of the questionnaire) and reliance on self-reported measures without clinical verification or longitudinal follow-up. Moreover, differences between crisis contexts (public health vs. security emergency) may constrain strict comparability despite methodological consistency. CONCLUSION During the Iron Swords war, patients with hematological malignancies experienced greater depressive symptom severity than during the COVID-19 pandemic, despite fewer disruptions in care. Their concerns shifted from isolation and contagion fears to war-related distress, fear, and anger toward sociopolitical instability. These findings emphasize the necessity of embedding systematic psychological screening, psychosocial, and integrative support into hematology services during wartime, maintaining transparent access pathways, and leveraging familial and social networks to enhance resilience. Tailored interventions targeting empirically identified risk groups rather than specific diagnoses should form the cornerstone of crisis-responsive hematologic care. Declarations Funding: The research received no funding. Conflicts of interest/Competing interests : The authors declare there was no conflict of interest. Ethics approval : The study was approved by the Institutional Review Board of Bnai Zion Medical Center, in accordance with the Declaration of Helsinki. Consent to participate : No informed consent signing was required since the survey was anonymous, and it was made clear to all involved before filing in the questionnaire that the data will be used for statistical analyses and research purposes. Consent for publication : N/A. Availability of data and material : All data are stored in a repository and can be made available as demand. Author Contribution ILY, GS, VS and TT contributed in constructing the study design, patient recruitment, article writing and reviewing. References Levi-Belz Y, Groweiss Y, Blank C, Neria Y. PTSD, depression, and anxiety after the October 7, 2023 attack in Israel: a nationwide prospective study. eClinicalMedicine. 2024;68:102418. Bellali T, Manomenidis G, Meramveliotaki E, Minasidou E, Galanis P. The impact of anxiety and depression in the quality of life and psychological well-being of Greek hematological cancer patients on chemotherapy. Psychology, Health and Medicine. 2020;25(2):201–13. Zaorsky NG, Zhang Y, Tuanquin L, Bluethmann SM, Park HS, Chinchilli VM. Suicide among cancer patients. Nature Communications. 2019;10(1):1–7. Levy I, Sharf G, Norman S, Tadmor T. The impact of COVID-19 on patients with hematological malignancies: the mixed-method analysis of an Israeli national survey. Support Care Cancer. 2021;29(12):7591–9. Kalagy T, Braun-Lewensohn O, Abu-Kaf S. Psychological distress among Israelis during crisis: A comparison between COVID-19 and the Iron Swords War. Psychiatry Res. 2025 June;348:116491. Kroenke K, Spitzer RL, Williams JBW. The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine. 2001;16(9):606–13. Boyatzis R. Transforming qualitative information. SAGE. 1998. 200 p. Roberts CW, Roberts BCW. Text analysis for the social sciences: methods for drawing statistical inferences from texts and transcripts. Lawrence Erlbaum Associates. 1997. 328 p. Guest G, MacQueen KM, Namey EE. Applied Thematic Analysis. SAGE. 2012. 320 p. Corbin J, Strauss A. Basics of Qualitative Research. 2015. 1–456 p. Elo S, Kyngäs H. The qualitative content analysis process. Journal of Advanced Nursing. 2008;62(1):107–15. Kuczmarski TM, Roemer L, Odejide OO. Depression in patients with hematologic malignancies: The current landscape and future directions. Blood reviews. 2024;65. Doshi SD, Charvadeh YK, Seier K, Bange EM, Daly B, Lipitz-Snyderman A, et al. Perspectives on Telemedicine Visits Reported by Patients With Cancer. JAMA Netw Open. 2024;7(11):e2445363–e2445363. Kakani P, Singer AE, Cui M, Villaflores CW, Vangala S, Cuevas MA, et al. Association between telehealth use in oncology and downstream utilization at a large academic health system. Journal of telemedicine and telecare. 2024;31(9):1326. Lin C, Burningham ZR, Rowe KG, Anglin-Foote T, Maddox M, Friedman DR, et al. Telemedicine-supervised cancer therapy for patients with an aggressive lymphoma and metastatic lung cancer in the U.S. Veterans Affairs National TeleOncology Service. Journal of Clinical Oncology. 2023 June 1; Schechtman EG, Hay DE, Schwartz I, Neria Y, Roe D. The unfolding of psychological distress following the October 7 attack on Israel: The impact of exposure, gender, and event centrality. Psychiatry Research. 2025;344:116356. Limone P, Toto GA, Messina G. Impact of the COVID-19 pandemic and the Russia-Ukraine war on stress and anxiety in students: A systematic review. Frontiers in Psychiatry. 2022;13:1081013. Ben-Arye E, Gressel O, Keshet Y, Zaritsky V, Kassem S, Segev Y, et al. War and Cancer: Exploring Patient Narratives in a Randomized Integrative Oncology Study. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 12 Mar, 2026 Reviews received at journal 12 Mar, 2026 Reviewers agreed at journal 13 Feb, 2026 Reviews received at journal 02 Jan, 2026 Reviewers agreed at journal 12 Dec, 2025 Reviewers invited by journal 02 Dec, 2025 Editor assigned by journal 02 Dec, 2025 Submission checks completed at journal 03 Nov, 2025 First submitted to journal 01 Nov, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8005031","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":554824849,"identity":"82b5ce4a-eecd-4d26-8390-cea0b2d414dd","order_by":0,"name":"Ilana Levy Yurkovski","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9UlEQVRIiWNgGAWjYDACZuYGIGnDww9iMzBIQIUNLPBoYQRpSZOTbEPVIoFbCwNYy2Fjg2NgLXCAW4t8O2Pj54Kaw4mb7zcf/Fy4w0LOnIH54QeGAtxaDA4zNkvPOJaeuO0YW7L0zDMSxpYNbMYS+BxmAPSLNA+bNVALjxkzb5tE4oYDDGZ4/SLfzNj8m+cfc+LmNv5vUC3s3/B7/zBjmzRvm7OxARsPG1QLD35bgH5ps+btS5OTOJZmDNQrYWxwmKdYIgGfw/oPH77N8w0Ylc2HH37mbauTMzjevvHDhz82uB2GCUCxk0CKhlEwCkbBKBgFGAAAxLBGDG19y+0AAAAASUVORK5CYII=","orcid":"","institution":"The Ruth and Bruce Rappaport faculty of medicine","correspondingAuthor":true,"prefix":"","firstName":"Ilana","middleName":"Levy","lastName":"Yurkovski","suffix":""},{"id":554824850,"identity":"ca86eda1-f015-429e-952a-ca806f233c40","order_by":1,"name":"Giora Sharf","email":"","orcid":"","institution":"Halil Haor non-profit organization for patients with Leukemia and Lymphoma","correspondingAuthor":false,"prefix":"","firstName":"Giora","middleName":"","lastName":"Sharf","suffix":""},{"id":554824851,"identity":"3659e89c-5b3b-4b94-b025-08f480916311","order_by":2,"name":"Varda Shoam","email":"","orcid":"","institution":"AMEN, Israeli Association of Myeloma Patients","correspondingAuthor":false,"prefix":"","firstName":"Varda","middleName":"","lastName":"Shoam","suffix":""},{"id":554824852,"identity":"7aac44ae-3aac-4cbf-b33b-c12e5f595df7","order_by":3,"name":"Tamar Tadmor","email":"","orcid":"","institution":"The Ruth and Bruce Rappaport faculty of medicine","correspondingAuthor":false,"prefix":"","firstName":"Tamar","middleName":"","lastName":"Tadmor","suffix":""}],"badges":[],"createdAt":"2025-11-01 10:38:25","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8005031/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8005031/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":97655037,"identity":"b7473183-9e3c-4ade-bd85-8401ab58e6ab","added_by":"auto","created_at":"2025-12-08 07:07:45","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":109731,"visible":true,"origin":"","legend":"","description":"","filename":"Theimpactofwaronpatientswithhematologicaldiseases.docx","url":"https://assets-eu.researchsquare.com/files/rs-8005031/v1/5996013445fd4339ae64f813.docx"},{"id":97655036,"identity":"cbf9ce15-4fac-4748-9f3a-acb8b69e76d1","added_by":"auto","created_at":"2025-12-08 07:07:45","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":5802,"visible":true,"origin":"","legend":"","description":"","filename":"2ab04953cdbf4bcaa8523648fcf0db9e.json","url":"https://assets-eu.researchsquare.com/files/rs-8005031/v1/a977b7df2ba1fa46920f01ab.json"},{"id":97655040,"identity":"092f6fbc-0040-4c84-b412-7ce298325cd3","added_by":"auto","created_at":"2025-12-08 07:07:45","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":81389,"visible":true,"origin":"","legend":"","description":"","filename":"2ab04953cdbf4bcaa8523648fcf0db9e1enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-8005031/v1/889cd9795a464aba902847cf.xml"},{"id":97655035,"identity":"97202a94-50c8-4882-a58f-ccb406df38eb","added_by":"auto","created_at":"2025-12-08 07:07:45","extension":"png","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":39202,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8005031/v1/b833d9aa90b43f55dbe26683.png"},{"id":97655038,"identity":"b0aee051-7b10-458b-8a3f-cbef634621c8","added_by":"auto","created_at":"2025-12-08 07:07:45","extension":"xml","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":79597,"visible":true,"origin":"","legend":"","description":"","filename":"2ab04953cdbf4bcaa8523648fcf0db9e1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8005031/v1/d3726827ba0d6ed8de323570.xml"},{"id":97655041,"identity":"3f118bcb-7776-467f-a385-1823bec45e71","added_by":"auto","created_at":"2025-12-08 07:07:45","extension":"html","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":85806,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8005031/v1/5510f30c09e708562722969e.html"},{"id":97655034,"identity":"f7d629ee-48c6-4f35-8d84-b33830ce047b","added_by":"auto","created_at":"2025-12-08 07:07:45","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":40950,"visible":true,"origin":"","legend":"\u003cp\u003eDepression assessment by Patient Health Questionnaire 9 (PHQ-9)\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8005031/v1/85908c65dbec4a52bd8f3e66.png"},{"id":97674268,"identity":"c092801b-cd15-419e-947a-dd4f884f0ce6","added_by":"auto","created_at":"2025-12-08 09:42:51","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":943247,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8005031/v1/9e7078db-0c1c-46af-8743-bda395e664a6.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Coping of patients with hematological malignancies with the Iron Swords war: The mixed- method analysis of an Israeli national survey","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eThe Iron Swords war, which erupted on October 7, 2023, profoundly disrupted daily life in Israel and reshaped the experience of both citizens and patients with chronic diseases (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Beyond the immediate physical threat, the persistent reality of air-raid sirens, repeated rushes to shelters several times a day, and the uncertainty of when and where the next attack might occur became part of the daily routine. During this period, the prevalence of probable post-traumatic stress disorder (PTSD) and depression nearly doubled in the Israeli population, with direct exposure to the attack contributing significantly to these findings (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Many communities were evacuated, while numerous hospitals and outpatient clinics were repeatedly relocated between protected areas and regular wards to ensure continuity of care. Health personnel often juggled their clinical duties while coping with the mobilization or loss of family members. Nearly every family was personally affected, whether through a relative serving in the reserves, being displaced, or among the kidnapped.\u003c/p\u003e\u003cp\u003ePrior to the war, the emotional burden of chronic illness, including depression, had been studied in various patient populations. Among patients with hematological malignancies, depression was reported in approximately 54% of cases in a Greek study and was associated with reduced quality-of-life (QoL) and impaired cognitive functioning (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Suicide attempts have also been shown to be prevalent among cancer patients in general, and particularly among those with hematological malignancies (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). In Israel, a survey conducted during the COVID-19 pandemic demonstrated that 42% of patients with haemato-oncological diseases suffered from at least moderate depression, with higher rates observed among patients with chronic myeloid leukemia, while main ways to cope with difficulties in this period included family or friends and staying busy (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eMore recently, a study found that psychological distress in the general Israeli population was more severe during the Iron Swords war compared to the COVID-19 pandemic. This distress was strongly and negatively correlated with both hope and sense of coherence (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAgainst this backdrop, the aim of the present study was to evaluate demographic and clinical factors associated with emotional distress in patients with hematological malignancies during the Iron Swords war in Israel, and to compare selected findings with data previously reported from a similar survey conducted during the COVID-19 pandemic in Israel (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eStudy design\u003c/span\u003e: This was a cross-sectional survey conducted among patients with hematological malignancies during the Iron Swords war in Israel, approximately two years after the onset of the conflict. The study was reviewed and approved by the Institutional Review Board of Bnai Zion Medical Center in accordance with the declaration of Helsinki (approval number BNZ-25-0083). Data was collected in September 2025. The survey was distributed via Google Forms platform and disseminated through social networks, email, telephone, and patient-organization chat groups (Halil Haor, AMEN). Four reminders to fill in the survey in Hebrew were sent in these platforms during the study period.\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eParticipants\u003c/span\u003e: Eligible participants were Hebrew-speaking adults (age 18 years and older) with hematological malignancies. Formal written consent was not required because the survey was anonymous. Before completing the questionnaire, participants were informed that the collected data would be used exclusively for statistical analyses and research purposes.\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eQuestionnaires\u003c/span\u003e: The questionnaire was adapted from a previously reported survey during the COVID-19 pandemic (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). It included 13 socio-demographic and medical baseline items, 10 questions concerning the management of hematological disease during the Iron Swords war, and 4 questions regarding social and emotional aspects during the war, including degree of involvement (e.g., relatives injured, murdered, or serving in the army). In addition, 2 questions assessed fears during the war on a 1\u0026ndash;7 Likert scale. Participants also completed the Patient Health Questionnaire-9 (PHQ-9), a validated instrument for assessing depression severity and its impact on daily functioning, with a validated Hebrew translation (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). PHQ-9 total scores (range 0\u0026ndash;27) categorize depression as none/minimal (0\u0026ndash;4), mild (\u003cspan additionalcitationids=\"CR6 CR7 CR8\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), moderate (\u003cspan additionalcitationids=\"CR11 CR12 CR13\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), moderately severe (15\u0026ndash;19), or severe (20\u0026ndash;27). Finally, participants answered three open-ended questions addressing perceived difficulties, supportive resources, and suggestions to alleviate current challenges. Quantitative and qualitative analyses were conducted using a mixed-methods approach.\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eStatistical analysis\u003c/span\u003e: Descriptive statistics were calculated for all demographic and clinical variables. Continuous variables were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD) and median with interquartile range (IQR), while categorical variables were expressed as proportions. Comparisons between the Iron Swords and COVID-19 surveys were performed using the t-test for normally distributed continuous variables, and the independent Chi-square test or Fisher\u0026rsquo;s exact test for categorical variables. Multivariate logistic regression analysis was performed to adjust for sociodemographic and clinical covariates influencing PHQ-9 depression categories. Odds ratios (ORs) with 95% confidence intervals (CIs) were reported, with p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 considered statistically significant. In addition, multivariate Poisson regression was applied to account for covariates influencing Likert-scale survey responses. Adjusted unstandardized regression coefficients (β) with 95% CIs were reported, with p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 considered statistically significant. Statistical analyses were conducted using IBM SPSS Statistics version 22.\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eThematic analysis\u003c/span\u003e: Responses to open-ended questions were analyzed using thematic analysis, a qualitative approach that identifies recurring themes or concepts in text (\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). The procedure involved open coding, category creation, and abstraction (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Codes were generated through inductive analysis, a method applied when prior research on the phenomenon is lacking or only fragmentary (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eBaseline characteristics\u003c/span\u003e: Of the 836 patients approached, 188 completed the survey (response rate: 22%). Among respondents, 83 (44%) had multiple myeloma (MM), 53 (28%) a lymphoproliferative disease (LPD), 22 (12%) a myelodysplastic or myeloproliferative neoplasm (MDS/MPN), 17 (9%) acute leukemia, and 13 (7%) chronic myeloid leukemia (CML). Baseline characteristics are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBaseline characteristics\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eBaseline characteristics\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDescriptive\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge\u003c/b\u003e (years)*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e65\u0026thinsp;\u0026plusmn;\u0026thinsp;13\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTime from diagnosis\u003c/b\u003e (years)*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7,3\u0026thinsp;\u0026plusmn;\u0026thinsp;9.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale \u0026ndash; N (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e76 (40%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eFamilial status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMarried / in couple \u0026ndash; N (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e145 (77%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDivorced \u0026ndash; N (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22 (12%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSingle \u0026ndash; N (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWidow \u0026ndash; N (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13 (7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNumber of children\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3\u0026thinsp;\u0026plusmn;\u0026thinsp;1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003eI live\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWith family \u0026ndash; N (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e155 (82%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAlone \u0026ndash; N (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31 (16%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNursing help \u0026ndash; N (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eReligion\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eJewish \u0026ndash; N (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e182 (97%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther \u0026ndash; N (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e\u003cb\u003eCountry of birth\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIsrael \u0026ndash; N (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e147 (78%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEurope \u0026ndash; N (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20 (11%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFormer USSR \u0026ndash; N (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAmerica \u0026ndash; N (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNorth Africa \u0026ndash; N (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAcademic \u0026ndash; N (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e131 (70%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eProfessional \u0026ndash; N (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e27 (14%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFinished high-school \u0026ndash; N (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26 (14%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDid not finish high-school \u0026ndash; N (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eOccupation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRetiree \u0026ndash; N (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e101 (54%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSalaried \u0026ndash; N (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e51 (27%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIndependent \u0026ndash; N (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18 (10%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDo not work (Housewife, unemployed, loss of capacity) \u0026ndash; N (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18 (10%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e\u003cb\u003eHematological disease\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMultiple Myeloma \u0026ndash; N (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e83 (44%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLymphoproliferative disease \u0026ndash; N (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e53 (28%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMyelodysplastic or Myeloproliferative \u0026ndash; N (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22 (12%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAcute leukemia \u0026ndash; N (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17 (9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChronic myeloid leukemia \u0026ndash; N (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13 (7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eRegion of Hematological Follow-up\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCenter of Israel \u0026ndash; N (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e116 (62%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNorthern Israel \u0026ndash; N (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e39 (21%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSouthern Israel \u0026ndash; N (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13 (7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eJerusalem region \u0026ndash; N (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20 (11%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003eTreatment for hematological disease\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo treatment \u0026ndash; N (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e61 (32%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOral only \u0026ndash; N (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e57 (30%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntravenous and/or subcutaneous \u0026ndash; N (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e70 (37%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003e* Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;Standard deviation\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eLegend\u003c/span\u003e: USSR: Union of Soviet Socialist Republics.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eManagement of hematological malignancy during Iron Swords war\u003c/span\u003e: During the war, most patients arrived at the hematology clinic either by private vehicle or on foot (60%), while 21% were accompanied by family members. Regarding home safety, 83% reported having access to a shelter within their building, 11% needed to leave the building for a nearby shelter, and 5% had no shelter available. A considerable proportion of patients were directly affected by the war: 84 (45%) had relatives serving in the army, 3 (2%) were evacuated, and 3 (2%) had a relative who was injured or killed. Despite these circumstances, treatment disruptions were limited: 10 patients (5%) experienced delays, 9 (5%) received an alternative treatment, and only in one patient (0.5%) CAR-T cell therapy was deferred during the war (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). When asked to compare the quality of clinic visits during the war to the pre-war period, using a 1\u0026ndash;4 scale (1\u0026thinsp;=\u0026thinsp;significantly worse, 4\u0026thinsp;=\u0026thinsp;slightly better), the median score was 3 [IQR 2\u0026ndash;3].\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eHematological management during Iron Swords\u0026rsquo; war\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eHematological management\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eDuring Iron Swords\u0026rsquo; war I come to hematological visits\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePersonal vehicle or walking\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e113 (60%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePublic transport\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30 (16%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTaxi\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAccompanied by family\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e40 (21%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eI have in my home\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSafe room\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e121 (64%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eShelter in building\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36 (19%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNearby shelter\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21 (11%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo shelter\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10 (5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eI was evacuated from my home following the war\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eAt least one relative was recruited to the army since the beginning of the war\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e84 (45%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eAt least one relative was hurt or murdered during the war\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eI was supposed to receive treatment but it was delayed because of the war\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10 (5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eIf yes, delayed by\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;1 week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (40%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 week \u0026minus;\u0026thinsp;1 month\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (50%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;1 month\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (10%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eTreatment delay was\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIn my demand\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (40%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePhysician decision\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (60%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eI was supposed to receive CAR-T but it was delayed because of the war\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (0.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eI received an alternative treatment for my hematological disease due to the war\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9 (5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ePatients\u0026rsquo; fears during the Iron Swords war\u003c/span\u003e: Patients evaluated their fears on a 7-point Likert scale (1\u0026thinsp;=\u0026thinsp;almost never, 7\u0026thinsp;=\u0026thinsp;almost always).\u003c/p\u003e\u003cp\u003eFor the statement \u003cem\u003e\u0026ldquo;I am anxious about national security and the war in relation to my hematology clinic,\u0026rdquo;\u003c/em\u003e the mean score was 1.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4, with a median of 1 [IQR 1\u0026ndash;2]. Multivariate Poisson regression revealed that female sex (β\u0026thinsp;=\u0026thinsp;1.6 [1.1\u0026ndash;2.4], p\u0026thinsp;=\u0026thinsp;0.021) and LPD diagnosis (β\u0026thinsp;=\u0026thinsp;2.2 [1.1\u0026ndash;4.5], p\u0026thinsp;=\u0026thinsp;0.026) were independently associated with higher anxiety scores, whereas younger age was associated with lower scores (β\u0026thinsp;=\u0026thinsp;0.96 [0.95\u0026ndash;0.98], p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003cp\u003eFor the statement \u003cem\u003e\u0026ldquo;The hospital responds to my needs regarding anxiety related to the Iron Swords war\u0026rdquo;\u003c/em\u003e (1\u0026thinsp;=\u0026thinsp;not at all, 7\u0026thinsp;=\u0026thinsp;very much), the mean score was 5.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8, with a median of 6 [IQR 4\u0026ndash;7]. No demographic or clinical factors were associated with these responses.\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eDepression according to PHQ-9 questionnaire\u003c/span\u003e: The mean PHQ-9 score was 10.4\u0026thinsp;\u0026plusmn;\u0026thinsp;5.6, with a median of 9 [IQR 6\u0026ndash;14]. Among respondents, 26 (14%) had no or minimal depression, 70 (37%) mild depression, 48 (25%) moderate depression, 28 (15%) moderately severe depression, and 16 (9%) severe depression. Compared with data from the COVID-19 survey, patients during the war reported significantly higher PHQ-9 scores (10.4\u0026thinsp;\u0026plusmn;\u0026thinsp;5.6 vs. 9.2\u0026thinsp;\u0026plusmn;\u0026thinsp;5.9, p\u0026thinsp;=\u0026thinsp;0.022) and a more severe distribution across PHQ-9 categories (p\u0026thinsp;=\u0026thinsp;0.013; Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Multivariate logistic regression showed that depression severity was associated only with the wartime (vs. COVID-19) period (OR 1.9 [1.4\u0026ndash;2.8], p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and female sex (OR 1.6 [1.1\u0026ndash;2.1], p\u0026thinsp;=\u0026thinsp;0.007).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eOpen-ended questions\u003c/span\u003e: Thematic analysis revealed that the main difficulties patients faced during the Iron Swords war were fear and anger related to the war and government, reported by 71 patients (38%), physical symptoms attributable to the disease or its treatment, reported by 46 patients (25%), and anxiety related specifically to their hematological condition, described by 23 patients (12%), while 39 (21%) did not describe any fear or anxiety. These concerns did not differ significantly across disease subgroups (p\u0026thinsp;=\u0026thinsp;0.21).\u003c/p\u003e\u003cp\u003eWhen asked about coping mechanisms, patients most often cited support from family or friends (43 patients, 23%). Others mentioned relying on personal resources, art, or religion (16 patients, 8.5%), engaging in physical exercise (15 patients, 8%), turning to complementary medicine (14 patients, 7%), or remaining occupied through work and daily activities (12 patients, 6%). Fifty-nine patients (31%) did not mention any coping mechanism.\u003c/p\u003e\u003cp\u003eAs for potential solutions that might alleviate these difficulties, patients most frequently pointed to political or governmental change and resolution of war-related issues (40 patients, 21%). Additional suggestions included psychological support or opportunities for discussion with peers (24 patients, 13%), increased social and family activities (21 patients, 11%), and the positive influence of health improvements or favorable medical outcomes (12 patients, 6%). Finally, 78 (42%) patients did not mention any potential solution.\u003c/p\u003e\u003cp\u003eQuotations and keywords of the thematic analysis are presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThematic analysis of open-ended questions\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThemes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequency \u0026ndash; N (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eQuotations\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eKeywords (mentions)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003e1st question: Burdens/difficulties patients were dealing with during the Iron Swords war*\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFear and anger related to the war and government\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e71 (38%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ldquo;Uncertainty on war and kidnapped people\u0026rdquo;\u003c/p\u003e\u003cp\u003e\u0026ldquo;Hopelessness, dismantled country\u0026rdquo;\u003c/p\u003e\u003cp\u003e\u0026ldquo;Complete frustration about what happens in the country\u0026rdquo;\u003c/p\u003e\u003cp\u003e\u0026ldquo;Anger about the situation and hopelessness that it may change\u0026rdquo;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026ldquo;Kidnapped\u0026rdquo; (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u0026ldquo;War\u0026rdquo; (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u0026ldquo;Government\u0026rdquo; (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u0026ldquo;Reservists\u0026rdquo; (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePhysical manifestations related to the hematological condition or its treatment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e46 (25%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ldquo;Decreased cognitive status\u0026rdquo;\u003c/p\u003e\u003cp\u003e\u0026ldquo;Pain in the left hand\u0026rdquo;\u003c/p\u003e\u003cp\u003e\u0026ldquo;Fatigue, lack of desire to do anything\u0026rdquo;\u003c/p\u003e\u003cp\u003e\u0026ldquo;Pneumonitis following Bleomycin treatment\u0026rdquo;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026ldquo;Fatigue\u0026rdquo; (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u0026ldquo;Pain\u0026rdquo; (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u0026ldquo;Insomnia\u0026rdquo; (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFears related to the hematological disease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23 (12%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ldquo;Active disease\u0026rdquo;\u003c/p\u003e\u003cp\u003e\u0026ldquo;Uncertainty about the disease\u0026rdquo;\u003c/p\u003e\u003cp\u003e\u0026ldquo;Health state\u0026rdquo;\u003c/p\u003e\u003cp\u003e\u0026ldquo;Neurological dysfunction due to the disease\u0026rdquo;\u003c/p\u003e\u003cp\u003e\u0026ldquo;That the disease progresses\u0026rdquo;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026ldquo;Disease\u0026rdquo; (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u0026ldquo;Treatment\u0026rdquo; (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo difficulty or no answer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e39 (21%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003e2nd question: Main ways to cope with the mentioned difficulties**\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFamily or friends\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e43 (23%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ldquo;Familial support\u0026rdquo;\u003c/p\u003e\u003cp\u003e\u0026ldquo;Relationship with other people and routine\u0026rdquo;\u003c/p\u003e\u003cp\u003e\u0026ldquo;Meeting with family, friends, hiking\u0026rdquo;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026ldquo;Family\u0026rdquo; (25)\u003c/p\u003e\u003cp\u003e\u0026ldquo;Friends\u0026rdquo; (20)\u003c/p\u003e\u003cp\u003e\u0026ldquo;Children\u0026rdquo; (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePersonal resources (optimism, faith, art)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16 (8.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ldquo;Mobilizing internal resources and disconnect from the news\u0026rdquo;\u003c/p\u003e\u003cp\u003e\u0026ldquo;Music, podcasts, personal and spiritual empowerment with faith\u0026rdquo;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026ldquo;Music\u0026rdquo; (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u0026ldquo;Prayer\u0026rdquo; (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u0026ldquo;Serenity\u0026rdquo; (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u0026ldquo;Hope\u0026rdquo; (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePhysical exercise\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15 (8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ldquo;Walking\u0026rdquo;\u003c/p\u003e\u003cp\u003e\u0026ldquo;Physical effort\u0026rdquo;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026ldquo;Sport\u0026rdquo; (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u0026ldquo;Activity\u0026rdquo; (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eComplementary medicine\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14 (7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ldquo;Psychological support and complementary medicine\u0026rdquo;\u003c/p\u003e\u003cp\u003e\u0026ldquo;Mindfulness and mind-body therapy\u0026rdquo;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026ldquo;Mindfulness\u0026rdquo; (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u0026ldquo;Meditation\u0026rdquo; (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u0026ldquo;Complementary\u0026rdquo; (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBeing occupied\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12 (6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ldquo;Being part of the manifestations\u0026rdquo;\u003c/p\u003e\u003cp\u003e\u0026ldquo;Going to work and staying occupied\u0026rdquo;\u003c/p\u003e\u003cp\u003e\u0026ldquo;Some learning, some agriculture, gardening\u0026rdquo;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\"Work\" (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\"Occupy\" (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo way to cope to difficulties\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e59 (31%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003e3rd question: Main solutions that may have helped improving the mentioned difficulties***\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGovernment change and war issues\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40 (21%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ldquo;Change of the government\u0026rdquo;\u003c/p\u003e\u003cp\u003e\u0026ldquo;Coming back of the kidnapped people\u0026rdquo;\u003c/p\u003e\u003cp\u003e\u0026ldquo;Ending of the war\u0026rdquo;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026ldquo;War\u0026rdquo; (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u0026ldquo;Kidnapped\u0026rdquo; (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u0026ldquo;Government\u0026rdquo; (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eConversation with patients or psychologist\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24 (13%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ldquo;To talk about the situation with other patients\u0026rdquo;\u003c/p\u003e\u003cp\u003e\u0026ldquo;More emotional support in the hospital\u0026rdquo;\u003c/p\u003e\u003cp\u003e\u0026ldquo;Conversation with professional psychologist\u0026rdquo;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026ldquo;Conversation\u0026rdquo; (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u0026ldquo;Support\u0026rdquo; (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u0026ldquo;Psychologist\u0026rdquo; (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFamilial and social activities\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21 (11%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ldquo;Relationship with other people, going out to movies\u0026rdquo;\u003c/p\u003e\u003cp\u003e\u0026ldquo;More familial meetings\u0026rdquo;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026ldquo;Friends\u0026rdquo; (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u0026ldquo;Meeting\u0026rdquo; (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u0026ldquo;Family\u0026rdquo; (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHealth, normal medical results\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12 (6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ldquo;To be cured from this disease\u0026rdquo;\u003c/p\u003e\u003cp\u003e\u0026ldquo;Success of this treatment\u0026rdquo;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026ldquo;Treatment\u0026rdquo; (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u0026ldquo;Disease\u0026rdquo; (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo potential solution\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e78 (42%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e* Other difficulties mentioned: Loneliness, Fear related to work or economic issues.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e** Other ways to cope with the mentioned difficulties: Substance use (drugs or cannabis), Rest, Hematologist's support, Technology (e.g. internet, telephone)\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e*** Other potential solutions: Economic support, Physiotherapy, Better consideration from the system and the physicians, Rest and vacations, Substance use (drugs, cannabis)\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eIn this national survey conducted approximately two years into the Iron Swords war, we observed a high burden of depression among patients with hematological malignancies, despite minimal disruption to disease management. Anxiety specifically related to the security situation or to attending hematology clinics was generally low but more pronounced among women, older patients, and those with LPD. Importantly, patients rated institutional responsiveness favorably, suggesting that hematology services largely maintained accessibility and support during wartime. Qualitative findings revealed that fear and anger concerning the war and government (38%) were the dominant emotional burdens, while one-third of respondents reported no clear coping strategy (31%).\u003c/p\u003e\n\u003ch3\u003eClinical implications:\u003c/h3\u003e\n\u003cp\u003eWhen compared with our earlier national survey conducted during the COVID-19 pandemic (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e), notable contrasts emerge. The pandemic period was marked by widespread logistical barriers (37% reduced clinic attendance and 9% treatment delays) together with emotional distress dominated by isolation and loneliness. In contrast, the Iron Swords war was associated with fewer disruptions in care but significantly higher depression severity. These patterns are consistent with findings from population-based research showing greater psychological distress in the general Israeli population during the Iron Swords war compared with the COVID-19 period (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). The war’s ongoing and tangible threat, coupled with political instability and collective trauma, may provoke a deeper sense of helplessness and anger than the abstract biological threat of a pandemic. Together, these findings suggest that during wartime, external threat and societal stressors—not service interruption—are the primary drivers of psychological distress, whereas the pandemic’s impact was more related to isolation, contagion fear, and altered care routines.\u003c/p\u003e\u003cp\u003eOur study focused specifically on patients with hematological malignancies, a cohort known to experience higher baseline levels of anxiety and depression than the general population (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). In contrast to our COVID-19 survey, in which CML was associated with the most severe depression, diagnosis was not an independent predictor of depressive severity during the Iron Swords war. However, LPD patients exhibited greater anxiety regarding their hematologic care. This likely reflects their need for frequent in-person visits for parenteral therapy, which could not be deferred or shifted to telemedicine. As recent oncology studies demonstrate, telehealth can effectively maintain treatment continuity even during crises, providing high patient satisfaction (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e), fewer acute complications (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), and even potential integration for parenteral therapy delivery including among lymphoma patients (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Expanding telehealth options, especially for LPD patients, should therefore be a priority for hematology services during times of conflict.\u003c/p\u003e\u003cp\u003eOur findings also parallel population-level data showing surges in PTSD, anxiety, and depression during Iron Swords, with distress strongly correlated with diminished hope and sense of coherence (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). This convergence reinforces the idea that ambient war-related stressors—such as displacement, family mobilization, or exposure to media coverage—can overwhelm coping resources even when medical services remain operational. Thus, the locus of distress among hematology patients extends beyond disease-related concerns to encompass broader existential and societal dimensions.\u003c/p\u003e\u003cp\u003eWomen were again identified as particularly vulnerable, with female gender independently associated with both higher war-related anxiety and more severe PHQ-9 depression scores. This aligns with previous research showing that women tend to exhibit greater psychological morbidity following traumatic or prolonged crises, including the Iron Swords war itself (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Conversely, the finding that younger patients reported lower anxiety regarding hematology care contrasts with prior studies where younger age was linked to higher distress (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). One possible explanation is that older patients—who may face reduced mobility, greater dependence, and heightened mortality awareness—experienced stronger insecurity about clinic access and safety, whereas younger individuals may have demonstrated greater adaptability or resilience.\u003c/p\u003e\u003cp\u003eAs in 2021, family and friends remained the predominant coping resource, underscoring the protective role of close social bonds. Yet, the higher proportion of patients reporting no coping strategy (31%) and frequent calls for political resolution or systemic change reveal distress driven by macro-level uncertainty rather than medical circumstances. Nevertheless, requests for psychological support (13%) and social re-engagement (11%) highlight tangible opportunities for hematology clinics to collaborate with psycho-oncology and community-based services to provide emotional support, peer dialogue, and structured resilience interventions. Another coping mechanism underlined by 7% of patients was complementary and integrative medicine which may offer additional avenues for relief. Indeed, recent evidence from an Israeli randomized integrative oncology study demonstrated that manual-relaxation therapy with or without acupuncture produced immediate and meaningful reductions in emotional distress and anxiety, and improved pain control and overall wellbeing among cancer patients during Iron Swords war (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Such integrative oncology programs can create a therapeutic “safe space,” enhancing calmness and resilience even amid conflict. Embedding these approaches alongside psychosocial screening and support within hematology clinics may therefore represent an effective, patient-centered strategy to mitigate depression and anxiety during crises.\u003c/p\u003e\u003cp\u003eTaken together, our results underscore the need to adapt hematology practice in conflict settings. Maintaining continuity of care even through telehealth is critical, not only for medical outcomes but also for psychological security. Clear communication about safety, accessibility, and contingency planning can mitigate anxiety. Incorporating routine mental-health screening (e.g., PHQ-9 and brief PTSD assessments) into clinical visits may enable early identification of vulnerable patients. In parallel, hematology departments should integrate psychosocial and integrative services, including access to psychologists, virtual or in-person support groups, and evidence-based complementary modalities that enhance patients’ sense of coherence and control.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eStrengths and limitations\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eThe study’s strengths include replication of a validated national survey instrument enabling direct comparison across crises, and its mixed-methods design providing both quantitative and qualitative insights. Limitations include its cross-sectional design, potential selection bias favoring digitally connected patients, the large majority of Jewish patients (probably related to the Hebrew-only version of the questionnaire) and reliance on self-reported measures without clinical verification or longitudinal follow-up. Moreover, differences between crisis contexts (public health vs. security emergency) may constrain strict comparability despite methodological consistency.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eDuring the Iron Swords war, patients with hematological malignancies experienced greater depressive symptom severity than during the COVID-19 pandemic, despite fewer disruptions in care. Their concerns shifted from isolation and contagion fears to war-related distress, fear, and anger toward sociopolitical instability. These findings emphasize the necessity of embedding systematic psychological screening, psychosocial, and integrative support into hematology services during wartime, maintaining transparent access pathways, and leveraging familial and social networks to enhance resilience. Tailored interventions targeting empirically identified risk groups rather than specific diagnoses should form the cornerstone of crisis-responsive hematologic care.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFunding:\u003c/h2\u003e\u003cp\u003eThe research received no funding.\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eConflicts of interest/Competing interests\u003c/span\u003e: The authors declare there was no conflict of interest.\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eEthics approval\u003c/span\u003e: The study was approved by the Institutional Review Board of Bnai Zion Medical Center, in accordance with the Declaration of Helsinki.\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eConsent to participate\u003c/span\u003e: No informed consent signing was required since the survey was anonymous, and it was made clear to all involved before filing in the questionnaire that the data will be used for statistical analyses and research purposes.\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eConsent for publication\u003c/span\u003e: N/A.\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eAvailability of data and material\u003c/span\u003e: All data are stored in a repository and can be made available as demand.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eILY, GS, VS and TT contributed in constructing the study design, patient recruitment, article writing and reviewing.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLevi-Belz Y, Groweiss Y, Blank C, Neria Y. PTSD, depression, and anxiety after the October 7, 2023 attack in Israel: a nationwide prospective study. eClinicalMedicine. 2024;68:102418.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBellali T, Manomenidis G, Meramveliotaki E, Minasidou E, Galanis P. The impact of anxiety and depression in the quality of life and psychological well-being of Greek hematological cancer patients on chemotherapy. Psychology, Health and Medicine. 2020;25(2):201\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZaorsky NG, Zhang Y, Tuanquin L, Bluethmann SM, Park HS, Chinchilli VM. Suicide among cancer patients. Nature Communications. 2019;10(1):1\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLevy I, Sharf G, Norman S, Tadmor T. The impact of COVID-19 on patients with hematological malignancies: the mixed-method analysis of an Israeli national survey. Support Care Cancer. 2021;29(12):7591\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKalagy T, Braun-Lewensohn O, Abu-Kaf S. Psychological distress among Israelis during crisis: A comparison between COVID-19 and the Iron Swords War. Psychiatry Res. 2025 June;348:116491.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKroenke K, Spitzer RL, Williams JBW. The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine. 2001;16(9):606\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBoyatzis R. Transforming qualitative information. SAGE. 1998. 200 p.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRoberts CW, Roberts BCW. Text analysis for the social sciences: methods for drawing statistical inferences from texts and transcripts. Lawrence Erlbaum Associates. 1997. 328 p.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGuest G, MacQueen KM, Namey EE. Applied Thematic Analysis. SAGE. 2012. 320 p.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCorbin J, Strauss A. Basics of Qualitative Research. 2015. 1\u0026ndash;456 p.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eElo S, Kyng\u0026auml;s H. The qualitative content analysis process. Journal of Advanced Nursing. 2008;62(1):107\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKuczmarski TM, Roemer L, Odejide OO. Depression in patients with hematologic malignancies: The current landscape and future directions. Blood reviews. 2024;65.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDoshi SD, Charvadeh YK, Seier K, Bange EM, Daly B, Lipitz-Snyderman A, et al. Perspectives on Telemedicine Visits Reported by Patients With Cancer. JAMA Netw Open. 2024;7(11):e2445363\u0026ndash;e2445363.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKakani P, Singer AE, Cui M, Villaflores CW, Vangala S, Cuevas MA, et al. Association between telehealth use in oncology and downstream utilization at a large academic health system. Journal of telemedicine and telecare. 2024;31(9):1326.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLin C, Burningham ZR, Rowe KG, Anglin-Foote T, Maddox M, Friedman DR, et al. Telemedicine-supervised cancer therapy for patients with an aggressive lymphoma and metastatic lung cancer in the U.S. Veterans Affairs National TeleOncology Service. Journal of Clinical Oncology. 2023 June 1;\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSchechtman EG, Hay DE, Schwartz I, Neria Y, Roe D. The unfolding of psychological distress following the October 7 attack on Israel: The impact of exposure, gender, and event centrality. Psychiatry Research. 2025;344:116356.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLimone P, Toto GA, Messina G. Impact of the COVID-19 pandemic and the Russia-Ukraine war on stress and anxiety in students: A systematic review. Frontiers in Psychiatry. 2022;13:1081013.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBen-Arye E, Gressel O, Keshet Y, Zaritsky V, Kassem S, Segev Y, et al. War and Cancer: Exploring Patient Narratives in a Randomized Integrative Oncology Study.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"supportive-care-in-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jscc","sideBox":"Learn more about [Supportive Care in Cancer](https://www.springer.com/journal/520)","snPcode":"520","submissionUrl":"https://submission.nature.com/new-submission/520/3","title":"Supportive Care in Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Hematological malignancies, Iron Swords war, Survey, Coping, Depression, Mixed-methods","lastPublishedDoi":"10.21203/rs.3.rs-8005031/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8005031/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003ePatients with hematological malignancies are vulnerable to psychological distress in times of crisis. We evaluated emotional burden, coping, and care continuity during the Iron Swords war in Israel and compared findings to a prior COVID-19 survey.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA national cross-sectional survey was conducted in September 2025 among Hebrew-speaking patients with hematological malignancies. Data included sociodemographic and clinical items, disease management, fears (Likert scales), the Patient Health Questionnaire-9 (PHQ-9), and three open-ended questions analyzed thematically. Results were compared with a similar 2021 COVID-19 survey.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eOf 836 patients approached, 188 responded (22%). War affected many patients: 45% had a relative recruited to the army, and 2% reported evacuation or a family member injured/killed. Treatment disruptions were limited (5% delays, 5% alternative therapy, one deferred CAR-T). Depression was frequent (mean PHQ-9 was 10.4\u0026thinsp;\u0026plusmn;\u0026thinsp;5.6), with 49% in moderate-to-severe ranges, significantly higher than during COVID-19 (9.2\u0026thinsp;\u0026plusmn;\u0026thinsp;5.9, p\u0026thinsp;=\u0026thinsp;0.022). Female sex and the wartime period independently predicted depression severity. Anxiety regarding clinic safety was generally low but higher in women, older and lymphoproliferative patients. Thematic analysis revealed fear/anger about war and government (38%) as the most common difficulty, while family support (23%) was the main coping resource.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eCompared to the COVID-19 pandemic, the Iron Swords war was associated with greater psychological distress despite fewer care disruptions. Hematology services should incorporate systematic screening and psychosocial support to safeguard patient well-being during crises.\u003c/p\u003e","manuscriptTitle":"Coping of patients with hematological malignancies with the Iron Swords war: The mixed- method analysis of an Israeli national survey","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-08 07:07:40","doi":"10.21203/rs.3.rs-8005031/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-12T16:32:48+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-12T14:49:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"93957132630635998046210035496634700718","date":"2026-02-13T06:15:16+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-02T16:03:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"261649282660581811494674916113433474096","date":"2025-12-12T20:11:21+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-02T19:12:15+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-02T19:10:29+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-03T10:43:45+00:00","index":"","fulltext":""},{"type":"submitted","content":"Supportive Care in Cancer","date":"2025-11-01T10:30:57+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"supportive-care-in-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jscc","sideBox":"Learn more about [Supportive Care in Cancer](https://www.springer.com/journal/520)","snPcode":"520","submissionUrl":"https://submission.nature.com/new-submission/520/3","title":"Supportive Care in Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"c596b040-b671-4c75-9add-f846736e2146","owner":[],"postedDate":"December 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-05-24T02:09:02+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-08 07:07:40","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8005031","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8005031","identity":"rs-8005031","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}