Abstract
Breast cancer has been the most commonly diagnosed type of cancer in Palestine for 10 years. Each treatment option is associated with a risk of developing a number of adverse effects. Breast cancer predominantly affects middle-aged and older women, who are also at increased risk of developing symptomatic dry eye (SDE). Therefore, this study was conducted to determine the prevalence and severity of SDE disease and examine its association with chemotherapy and other factors among patients with different stages of breast cancer in the West Bank, Palestine. A correlational cross-sectional study was conducted between September 2021 and September 2022 at Al-Watani Hospital, An-Najah National University Hospital (Nablus), and Beit Jala Hospital (Bethlehem). A clinic-based convenience sample of breast cancer patients who had completed at least two cycles of neoadjuvant or adjuvant chemotherapy or targeted therapy was recruited. Patients with recent eye infections or surgery, ocular trauma, Sjögren’s syndrome, or other ocular surface diseases were excluded. SDE prevalence and severity were assessed via the Arabic Ocular Surface Disease Index (OSDI), and the National Comprehensive Cancer Network-Functional Assessment of Cancer Therapy-Breast Cancer Symptom Index (NFBSI-16) was used to evaluate chemotherapy-related symptoms. Analyses were conducted using available-case analysis for descriptive and bivariate comparisons, whereas multivariable regression models employed listwise deletion.A total of 316 patients were screened; 111 were excluded on the basis of the eligibility criteria, leaving 205 for analysis. Questionnaires with partial missing responses were included via a complete-case approach. Among the analysed patients, 144 (70.2%) had SDE. Reported associations are unadjusted. The severity of SDE was mild in 36 (17.56%) patients, moderate in 30 (14.63%) patients and severe in 78 (38.05%) patients. No associations were found between the type of anticancer therapy received and the occurrence or severity of SDE. In terms of quality of life, a longer disease duration and the use of gemcitabine, everolimus and exemestane were associated with poorer physical activity. Finally, a significant negative correlation was found between the total NFBSI-16 score and the OSDI score (R = -0.47; P < 0.001). SDE is highly prevalent among breast cancer patients in Palestine, affecting more than one-third of those with severe symptoms. Integrating routine ocular symptom screening into oncology care may help identify and manage this underrecognized condition. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1038/s41598-026-44663-6.