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The Cancer Care Crisis in Ukraine

How You Can Help

Eastman, Peggy

doi: 10.1097/01.COT.0000830032.60027.e0
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War in Ukraine:
War in Ukraine

As Russian forces continue to bombard Ukraine, concerns are mounting about the most vulnerable citizens there, including the ill. The American Society of Clinical Oncology (ASCO) and the European Cancer Organisation (ECO) sponsored an online briefing to focus on the dire situation for cancer patients and what can be done to help.

More than 3 million people are refugees fleeing Ukraine, and millions more have been displaced within the country. According to the American Cancer Society (ACS), more than 179,000 newly diagnosed patients with cancer are among the Ukrainian citizens suffering from Russia's aggression; disruptions to cancer treatment “pose a grave risk to their very survival,” noted the ACS.

“We all want to do whatever we can” to make it easier for cancer patients caught in the crossfire to continue their treatment, said ASCO President-Elect Eric Winer, MD, FASCO, Director of the Yale Cancer Center and Physician-in-Chief of Smilow Cancer Hospital at Yale New Haven.

ECO President Andreas Charalambous, PhD, said he has been “overwhelmed” by all the concerned professionals joining the ECO-ASCO Special Network: Impact of the War in Ukraine on Cancer, a network set up to help cancer patients affected by the conflict (https://bit.ly/3703ZJh). Charalambous, who is Professor and Foundation Executive Dean at the University of Nicosia Medical School in Cypress, issued an invitation to those participating in the briefing to join this helping network.

Trying to process the refugee flow is very daunting because “the numbers are absolutely staggering,” said Richard Sullivan, MD, PhD, a member of the World Health Organization Emergency Committee, as well as Director of the Institute of Cancer Policy at King's College, London. At border crossings, “we've got lots of refugees coming across who are very vulnerable.”

Cancer patients are especially vulnerable because “by and large the triage is not focusing on non-communicable diseases,” Sullivan said, noting that cancer care for refugees in host countries is going to be overwhelming, and “there's going to be a real issue around fairness and equity, which Europe is going to have to address.” Because cancer is not at the top of the list of most pressing refugee concerns right now, it will be up to ASCO and ECO to help ensure care for displaced cancer patients, Sullivan stressed.

“Please stay involved” following the briefing, urged Julie Gralow, MD, FACP, FASCO, ASCO's Chief Medical Officer who served as the briefing's moderator. She urged briefing participants to check out ASCO's main Ukraine assistance hub, www.asco.org/Ukraine. She cited ASCO's statement strongly condemning the war, which states in part: “Interruption of cancer care simply adds to the massive pain and needless suffering caused by war.” Gralow noted that, as a global cancer society, ASCO represents oncology professionals in Ukraine and its neighboring countries, including Poland, Romania, Moldova, Slovakia, and Hungary.

Gralow said that ASCO and the ACS are cooperating on a volunteer corps of clinicians to offer guidance to people with cancer and their families affected by the war, in collaboration with the Sidney Kimmel Cancer Center-Jefferson Health. She also noted that ASCO is providing volunteers to help respond to queries coming from the ACS National Cancer Information Center from hospitals, clinicians, and patients in Ukraine and neighboring countries. In addition, ASCO's website, www.cancer.net, provides patient materials.

For Gralow, the current conflict is personal, dating back to 1997, when the U.S. Agency for International Development awarded $3.8 million to assist the Ukrainian Ministry of Health in strengthening its breast cancer services. She was asked by the Program for Appropriate Technology in Health (PATH) to serve as a medical oncology consultant on the 3-year Breast Cancer Assistance Program, and has said she found the Ukrainians warm, generous, and hospitable. Subsequently, she initiated the Women's Empowerment Cancer Advocacy Network (WE CAN) in Eastern Europe/Central Asia. She called the current situation in Ukraine “a tragedy,” but said that seeing the resilience of the people “gives us hope.”

In an overview of the situation on the ground in Ukraine, Andriy Hrynkiv, MD, a surgical oncologist at Lviv Regional Cancer Center and a member of the ASCO Central & Eastern European Regional Council, described violence, shelling, and destroyed hospitals among buildings reduced to rubble. He said it is not possible to assess accurately the numbers of civilians killed in the fighting because bodies are buried under the rubble. Lack of availability of medical records lost in the destruction is a big issue.

Hrynkiv compared the bombardment of the Ukrainian city of Mariupol to the bombardment of Aleppo in Syria. He said physicians are continuing to treat patients in self-equipped bomb shelters, but noted it is hard to evacuate patients because some cannot walk. Hrynkiv added that health professionals treating patients are “facing extreme psychological stress and even threats on their lives.” He thanked all those who are helping Ukraine, and said this help is “priceless.”

Jacek Jassem, MD, PhD, Professor of Clinical Oncology and Radiotherapy at the Medical University of Gdansk in Poland, said many cancer patients from Eastern Ukraine are being transferred to Western Ukraine for care because it is considered safer. But Jassem, a board member of the Polish Cancer League, said these hospitals have major problems with supplies, such as radioactive iodine, as well as cancer medicines. He noted there are some 2 million Ukrainian refugees in Poland, so statistically by sheer numbers the population of cancer patients in Poland is increasing.

Jassem said, if patients are receiving radiotherapy in Ukraine, it is best for them to try to stay there, while chemotherapy courses can generally be continued elsewhere. He said the challenge is to identify refugee patients who need cancer care abroad and transport them to cancer centers in other countries that declare their willingness to take these refugee patients. However, he noted resources are limited.

“These patients feel lost when they are abroad,” said Jassem. He and his colleagues encourage patients to use social media and develop patient groups with which they can communicate so they don't feel so alone.

Nicoleta Antone, MD, a medical oncologist at the Institute of Oncology in Romania and a member of the ASCO Central & Eastern European Regional Council, decried the life-endangering interruption of care for cancer patients in Ukraine. She said more than 412,000 Ukrainian citizens have arrived in Romania, many with limited medical records. She noted that refugee cancer patients often present with locally advanced disease and suffer more complications. The good news for refugees arriving in Romania is that they can receive free medical care similar to that provided to Romanian citizens for 90 days, Antone noted.

Laura Makaroff, DO, the ACS Senior Vice President for Prevention and Early Detection, said the society's web site at www.cancer.org has Ukraine resources in various languages; the biggest download currently is “Coping with Cancer in a Disaster.” She said the ACS National Cancer Information Center has phone numbers for Ukraine, Poland, Romania, Hungary, Slovakia, and Moldova. Most of the calls coming in are from patients asking where they can find a facility to continue their treatment.

Makaroff also cited the value of the society's Clinician Volunteer Corps mentioned by Gralow, which has some 123 active volunteers (volunteerclinicians.cancer.org) who help provide information and guidance to professionals treating cancer patients in need. This service is especially needed now during the crisis in Ukraine.

Speakers at the briefing repeatedly emphasized the critical need for help to save lives as Ukraine fights the Russian invasion. The ASCO statement states: “From within Ukraine and the surrounding regions, we are hearing daily reports of cancer treatment interrupted by acts of war, including damage to medical facilities and shortage of critical supplies.”

Peggy Eastman is a contributing writer.

Cancer Resources During the Ukrainian Crisis

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