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

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.